Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France
Abstract
:1. Introduction
2. Methods
2.1. Study Population and Data Collection
2.2. Statistical Analyses
2.2.1. Sensitivity and Specificity of the Current Lead Risk Questionnaire
2.2.2. Logistic Regression Modeling
2.2.3. Performance Evaluation of Multivariable Models
2.2.4. Internal Validation of Performance of the Better Model
3. Results
3.1. Sensitivity and Specificity of the Current Lead Risk Questionnaire in Identifying BLLs Higher than 50 µg/L
Self-Reported Exposure Questions | Observed Responses in Saturn-Inf Sample (n = 3831) * | Estimated Prevalence in French Children <7 Years (N = 5102,537) | Observed Prevalence of BLLs ≥ 50 µg/L in Saturn-Inf Sample (n = 67) * | |
---|---|---|---|---|
n | % (95% CI) | n | % | |
Child recently arrived in France (<1 year) | ||||
No | 3802 | 99.8 (99.6; 99.9) | 65 | 98.5 |
Yes | 10 | 0.2 (0.1; 0.4) | 1 | 1.5 |
Child residing with someone who has been lead-poisoned | ||||
No | 3333 | 88.0 (86.0; 89.7) | 59 | 88.1 |
Yes | 3 | 0.04 (0.01; 0.1) | 0 | 0 |
Don’t know | 436 | 12.0 (10.3; 13.9) | 8 | 10.9 |
Adult occupation involves lead exposure | ||||
No | 2778 | 86.8 (84.9; 88.5) | 42 | 82.3 |
Yes | 461 | 13.2 (11.5; 15.0) | 9 | 17.6 |
Child drinking tap water where housing has lead pipes | ||||
No | 1770 | 49.4 (45.5; 53.8) | 23 | 34.3 |
Yes | 66 | 2.2 (1.3; 3.6) | 4 | 6,0 |
Don’t know | 1928 | 48.4 (44.8; 51.9) | 40 | 59.7 |
Child living in pre-1949 housing with peeling paint inside | ||||
No | 2465 | 71.8 (65.5; 78.6) | 36 | 57.1 |
Yes | 163 | 4.8 (3.6; 6.2) | 5 | 7.9 |
Don’t know | 1064 | 23.4 (20.2; 27.0) | 22 | 34.9 |
Child living in pre-1949 housing with recent renovation work inside | ||||
No | 2379 | 70.5 (62.6; 79.2) | 33 | 53.2 |
Yes | 290 | 7.5 (6.1; 9.4) | 9 | 14.5 |
Don’t know | 972 | 22.0 (19.1; 25.0) | 20 | 32.3 |
Child living in pre-1949 housing and having tendency to scrape off or nibble paint | ||||
No | 2589 | 75.5 (68.7; 82.6) | 36 | 55.4 |
Yes | 46 | 0.9 (0.6; 1.5) | 5 | 7.7 |
Don’t know | 1084 | 23.6 (20.4; 27.3) | 24 | 36.9 |
TP | FP | FN | TN | Missing Data (Don’t Knows and Missing) | Sensitivity (95%CI) * | Specificity (95%CI) * |
---|---|---|---|---|---|---|
23 | 831 | 17 | 1402 | 1558 | 0.51 (0.26; 0.75) | 0.66 (0.62; 0.70) |
3.2. Multivariable Predictive Models
Self-Report Exposure Questions | Observed Cases in BLLs ≥ 44 µg/L (n = 107) | Estimated Prevalence (%) in BLLs ≥ 44 µg/L | OR | 95% CI | ||
---|---|---|---|---|---|---|
Child recently arrived in France (<1 year) | 2 | 2.3 | 11.6 | 0.3 | 455.5 | |
Child having tendency to scrape off or nibble paint | 16 | 11.6 | 0.7 | 0.2 | 2.7 | |
Adult occupation involves lead exposure | 16 | 7.6 | 0.6 | 0.3 | 1.4 | |
Lead pipes | Type of drinking water | |||||
No | Bottled water | 24 | 29.2 | Reference level | ||
No | Tap water | 19 | 28.1 | 0.8 | 0.3 | 2.0 |
Yes | Bottled water | 2 | 0.5 | 0.1 | 0 | 1.1 |
Yes | Tap water | 4 | 6.9 | 32.6 | 1.7 | 626.6 |
Don’t know | Bottled water | 23 | 12.6 | 0.3 | 0.1 | 1.1 |
Don’t know | Tap water | 35 | 22.6 | 1.5 | 0.3 | 8.4 |
Housing age | Peeling paint inside the dwelling | |||||
Built post-1949 | No | 32 | 22.1 | Reference level | ||
Built post-1949 | Yes | 4 | 4.4 | 2.9 | 0.5 | 18.2 |
Built pre-1949 | No | 20 | 18.4 | 3.6 | 1.0 | 12.2 |
Built pre-1949 | Yes | 11 | 12.0 | 0.8 | 0.1 | 7.2 |
Don’t know | No | 23 | 36.9 | 6.2 | 1.3 | 29.6 |
Don’t know | Yes | 10 | 6.3 | 0.3 | 0.0 | 4.7 |
Housing age | Renovation works inside the dwelling | |||||
Built post-1949 | No | 27 | 18.4 | Reference level | ||
Built post-1949 | Yes | 11 | 8.5 | 1.2 | 0.4 | 3.7 |
Built pre-1949 | No | 18 | 19.9 | 3.6 | 1.0 | 12.2 |
Built pre-1949 | Yes | 13 | 10.2 | 0.8 | 0.2 | 4.2 |
Don’t know | No | 25 | 34.2 | 6.2 | 1.3 | 29.6 |
Don’t know | Yes | 8 | 8.7 | 0.6 | 0.1 | 3.3 |
Variables | Observed Cases for BLLs > 44 µg/L (n = 107) | Estimated Prevalence (%) for BLLs > 44 µg/L | OR | 95% CI | ||
---|---|---|---|---|---|---|
Gender of child | ||||||
Male | 60 | 47.8 | Reference level | |||
Female | 47 | 52.2 | 2.4 | 1.2 | 5.0 | |
Child recently arrived in France (<1 year) | ||||||
No | 104 | 97.7 | Reference level | |||
Yes | 2 | 2.3 | 6.4 | 0 | 1366.7 | |
Mother’s country of birth | ||||||
France | 73 | 69.9 | Reference level | |||
Other country | 33 | 30.1 | 2.9 | 1.2 | 6.8 | |
Parents smoke indoors | ||||||
No | 74 | 75.7 | Reference level | |||
<1 h/day | 13 | 12.0 | 3.1 | 0.9 | 10.4 | |
1–2 h/day | 6 | 2.6 | 0.6 | 0.2 | 2.2 | |
2–5 h/day | 6 | 2.2 | 0.1 | 0 | 0.6 | |
>5 h/day | 7 | 7.5 | 8.6 | 2.7 | 27.5 | |
Lead pipes | Type of drinking water | |||||
No | Bottled water | 24 | 29.2 | Reference level | ||
No | Tap water | 19 | 28.1 | 1.0 | 0.3 | 3.4 |
Yes | Bottled water | 2 | 0.5 | 0.1 | 0 | 1.5 |
Yes | Tap water | 4 | 6.9 | 16.6 | 0.2 | 1321.7 |
Don’t know | Bottled water | 23 | 12.6 | 0.2 | 0.1 | 0.9 |
Don’t know | Tap water | 35 | 22.6 | 1.1 | 0.2 | 6.0 |
Housing age | Peeling paint inside the dwelling | |||||
Built post-1949 | No | 32 | 22.1 | Reference level | ||
Built post-1949 | Yes | 4 | 4.4 | 3.1 | 0.4 | 25.0 |
Built pre-1949 | No | 20 | 18.4 | 3.1 | 1.1 | 8.5 |
Built pre-1949 | Yes | 11 | 12.0 | 0.8 | 0.1 | 11.0 |
Don’t know | No | 23 | 36.9 | 4.8 | 0.9 | 25.0 |
Don’t know | Yes | 10 | 6.3 | 0.1 | 0 | 4.1 |
Adult occupation involves lead exposure | ||||||
No | Reference level | |||||
Yes | 16 | 7.6 | 0.3 | 0.1 | 0.9 | |
Occupancy rate (number of people/number of rooms) | ||||||
Change from percentile 25 to percentile 75:0.7 to 1.1 | 0.6 | 0.3 | 1.1 | |||
Change from percentile 25 to percentile 95:0.7 to 1.7 | 1.4 | 0.8 | 2.6 | |||
Change from percentile 25 to percentile 99:0.7 to 3 | 3.6 | 2.0 | 6.4 | |||
Proportion of substandard pre-1949 housing per cadastral section or municipality | ||||||
Change from percentile 25 to percentile 75:0.8 to 6.0% | 5.0 | 4.8 | 5.3 | |||
Change from percentile 25 to percentile 95:0.8 to 15.5% | 14.2 | 13.5 | 15.0 | |||
Change from percentile 25 to percentile 99:0.8 to 29.3% | 27.7 | 26.3 | 29.1 |
3.3. Performance of Predictive Models
4. Discussion
4.1. Sensitivity and Specificity of the Current Lead Risk Questionnaire in Screening BLLs Higher than 50 µg/L
4.2. Proposal for a New Lead Risk Questionnaire
4.3. Limitations
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Etchevers, A.; Glorennec, P.; Le Strat, Y.; Lecoffre, C.; Bretin, P.; Le Tertre, A. Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France. Int. J. Environ. Res. Public Health 2015, 12, 15366-15378. https://doi.org/10.3390/ijerph121214989
Etchevers A, Glorennec P, Le Strat Y, Lecoffre C, Bretin P, Le Tertre A. Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France. International Journal of Environmental Research and Public Health. 2015; 12(12):15366-15378. https://doi.org/10.3390/ijerph121214989
Chicago/Turabian StyleEtchevers, Anne, Philippe Glorennec, Yann Le Strat, Camille Lecoffre, Philippe Bretin, and Alain Le Tertre. 2015. "Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France" International Journal of Environmental Research and Public Health 12, no. 12: 15366-15378. https://doi.org/10.3390/ijerph121214989