Statewide Assessment of Lead Poisoning and Exposure Risk Among Children Receiving Medicaid Services in Alaska

Objective. Lead poisoning is a well-recognized public health concern for children living in the United States. In 1992, Health Care Financing Administration (HCFA) regulations required lead poisoning risk assessment and blood lead testing for all Medicaid-enrolled children ages 6 months to 6 years. This study estimated the prevalence of blood lead levels (BLLs) ≥10 μg/dL (≥0.48 μmol/L) and the performance of risk assessment questions among children receiving Medicaid services in Alaska.Design. Measurement of venous BLLs in a statewide sample of children and risk assessment using a questionnaire modified from HCFA sample questions.Setting. Eight urban areas and 25 rural villages throughout Alaska.Patients. Nine hundred sixty-seven children enrolled in Medicaid, representing a 6% sample of 6-month- to 6-year-old Alaska children enrolled in Medicaid.Outcome Measure(s). Determination of BLL and responses to verbal-risk assessment questions.Results. BLLs ranged from <1 μg/dL (<0.048 μmol/L) to 21 μg/dL (1.01 μmol/L) (median, 2.0 μg/dL or 0.096 μmol/L). The geometric mean BLLs for rural and urban children were 2.2 μg/dL (0.106 μmol/L) and 1.5 μg/dL (0.072 μmol/L), respectively. Six (0.6%) children had a BLL ≥10 μg/dL; only one child had a BLL ≥10 μg/dL (11 μg/dL or 0.53 μmol/L) on retesting. Children whose parents responded positively to at least one risk factor question were more likely to have a BLL ≥10 μg/dL (prevalence ratio = 3.1; 95% confidence interval = 0.4 to 26.6); the predictive value of a positive response was <1%.Conclusions. In this population, the prevalence of lead exposure was very low (0.6%); only one child tested (0.1%) maintained a BLL ≥10 μg/dL on confirmatory testing; no children were identified who needed individual medical or environmental management for lead exposure. Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska. Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations. lead poisoning, child health services, mass screening, government regulations, Medicaid.