Identifying High-Risk ZIP Codes for Childhood Lead Exposure: A Statewide ZCTA-Level Priority List for North Carolina
release_lbdgwulyqfafvpmwepw6awskxe
by
Rashida Callender,
Carolina Avendano,
Mercedes A. Bravo,
Joshua Tootoo,
Ed Norman,
Marie Lynn Miranda
2024 Volume 85, Issue 2
Abstract
<jats:sec id="background"> <jats:title>Background</jats:title> Research has consistently shown that there is no safe blood lead level (BLL) for children. Despite progress in lead poisoning prevention, lead exposure remains a persistent threat to the health and neurological development of children. To identify high-risk ZIP codes for use by families and health care providers for the entire state of North Carolina, we developed a risk model using ZIP Code Tabulation Area (ZCTA)-level census data. </jats:sec> <jats:sec id="methods"> <jats:title>Methods</jats:title> We obtained all available BLL testing data from the North Carolina Department of Health and Human Services for the years 2010–2015 via data use agreement. We fit a multivariable regression model with the <jats:italic>ZCTA-level mean of log normalized BLLs</jats:italic> as the dependent variable and <jats:italic>ZCTA-level census data for known risk factors of childhood lead exposure</jats:italic> as predictors. We used this model to create a priority risk categorization. </jats:sec> <jats:sec id="results"> <jats:title>Results</jats:title> We organized ZCTAs into 20 quantiles, or priority risk categories, that can be used in local and statewide screening programs. The first six (of 20) quantiles were identified as particularly high-risk areas for childhood lead exposure. </jats:sec> <jats:sec id="limitations"> <jats:title>Limitations</jats:title> Because BLL testing is not universal, the BLL testing data used in this study are likely biased toward those most at risk for lead exposure. </jats:sec> <jats:sec id="conclusion"> <jats:title>Conclusion</jats:title> This study demonstrates the utility of ZCTA-level census data in identifying high-risk ZIP codes for childhood lead exposure, which can be used to ensure that the highest-risk children are tested in a timely manner. This approach can be replicated to address lead exposure nationally. </jats:sec>
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