Identifying the Blood Lead Reference Value Based on the Advisory Committee on Childhood Lead Poisoning Prevention Guidelines and Factors Associated with Elevated Blood Lead Levels among Preschool Children in Thailand, 2019
Keywords:blood lead reference value, elevated blood lead level, preschool children, Thailand
The blood lead reference value (BLRV) is used for guiding lead prevention and control measures. It is usually defined as the 97.5th percentile of the population-based blood lead level in each country. This study aims to determine the BLRV and factors associated with elevated (≥5 µg/dL) blood lead levels among children aged 1–5 years in Thailand. A cross-sectional study was conducted using secondary data extracted from a national survey, implemented in 171 hospitals during October 2018–September 2019. Demographic characteristics and potential risk factors including lead-related industries were collected. Multilevel logistic regression was used. Of 3,184 children included in the survey, the BLRV was 6.9 µg/dL. Three significant risk factors were identified: living near a lead factory (adjusted odds ratio (AOR) 2.09, 95% CI 1.27–3.42), exposure to the manufacture of fishing tackle (AOR 4.39, 95% CI 1.54–12.50), and exposure to the manufacture of shot and ammunition (AOR 6.30, 95% CI 1.81–21.93). Despite a calculated BLRV of 6.9 µg/dL, we propose a BLRV of 5 μg/dL in Thailand based on guidelines from the United Kingdom. Surveillance of blood lead levels should be established among children at high risk of lead exposure.
United States Environmental Protection Agency. Learn about Lead [Internet]. Washington: United States Environmental Protection Agency; [updated 2022 Sep 8, cited 2023 Mar 5]. <https://www.epa.gov/lead/learn-about-lead>
Obeng-Gyasi E. Sources of lead exposure in various countries. Rev Environ Health. 2019 Mar 26;34(1):25–34. doi:10.1515/reveh-2018-0037.
Al Osman M, Yang F, Massey IY. Exposure routes and health effects of heavy metals on children. Biometals. 2019 Aug;32(4):563–73.
Ramirez Ortega D, Gonzalez Esquivel DF, Blanco Ayala T, Pineda B, Gomez Manzo S, Marcial Quino J, et al. Cognitive impairment induced by lead exposure during lifespan: mechanisms of lead neurotoxicity. Toxics. 2021 Jan 28;9(2):23. doi:10.3390/toxics9020023.
Heidari S, Mostafaei S, Razazian N, Rajati M, Saeedi A, Rajati F. The effect of lead exposure on IQ test scores in children under 12 years: a systematic review and meta-analysis of case-control studies. Syst Rev. 2022 May 30;11(1):106. doi:10.1186/s13643-022-01963-y.
Coscia JM, Ris MD, Succop PA, Dietrich KN. Cognitive development of lead exposed children from ages 6 to 15 years: an application of growth curve analysis. Child Neuropsychol. 2003 Mar;9(1):10–21. doi:10.1076/chin.184.108.40.20698.
Division of Environmental Health Science and Practice, National Center for Environmental Health. National Health and Nutrition Examination Survey (NHANES) [Internet]. Atlanta: Centers for Disease Control and Prevention (US); [updated 2021 Nov 18; cited 2023 Mar 5]. <https://www.cdc.gov/nceh/lead/data/nhanes.htm>
Ettinger AS, Leonard ML, Mason J. CDC's lead poisoning prevention program: a long-standing responsibility and commitment to protect children from lead exposure. J Public Health Manag Pract. 2019 Jan/Feb;25 Suppl 1:S5–S12. doi:10.1097/PHH.0000000000000868.
Division of Environmental Health Science and Practice, National Center for Environmental Health. Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) [Internet]. Atlanta: Center for Disease Control and Prevention (US); [updated 2019 Jul 30; cited 2023 Mar 5]. <https://www.cdc.gov/nceh/lead/advisory/acclpp.htm>
Ruckart PZ, Jones RL, Courtney JG, LeBlanc TT, Jackson W, Karwowski MP, et al. Update of the blood lead reference value - United States, 2021. MMWR Morb Mortal Wkly Rep. 2021 Oct 29; 70(43):1509–12. doi:10.15585/mmwr.mm7043a4.
Health Data Center. Morbidity rate of lead poisoning in 2018 [dataset on Internet]. Nonthaburi: Ministry of Public Health (TH); [updated 2019 Jun 9; cited 2023 Mar 5]. <https://hdcservice.moph.go.th/hdc/reports/report.php?source=envocc/format2.php&cat_id=f16421e617aed29602f9f09d951cce68&id=3b4f3df4d17920d6ab4e94e57bf90a0f>
Bureau of Occupational and Environmental Diseases. An operational guideline for assessing the lead exposure situation under the project on “Smart children, stay safe and stay away from lead” [Internet]. Nonthaburi: Bureau of Occupational and Environmental Diseases (TH); 2019 [cited 2023 Mar 5]. <http://envocc.ddc.moph.go.th/uploads/media/manual/FROM2/guidelines.pdf>. Thai.
Pacer EJ, Palmer CD, Parsons PJ. Determination of lead in blood by graphite furnace atomic absorption spectrometry with Zeeman background correction: Improving a well-established method to support a lower blood lead reference value for children. Spectrochim Acta Part B At Spectrosc. 2022 Apr;190:106324. doi:10.1016/j.sab.2021.106324.
UK Health Security Agency. Lead Exposure in Children Surveillance System (LEICSS) annual report 2022 [Internet]. London: UK Health Security Agency; 2023 Jan 12 [cited 2023 Mar 5]. 35 p. <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1128326/hpr0123_LEICSS_2021.pdf>
Cao J, Li M, Wang Y, Yu G, Yan C. Environmental lead exposure among preschool children in Shanghai, China: blood lead levels and risk factors. PloS one. 2014 Dec 1;9(12): e113297. doi:10.1371/journal.pone.0113297.
Ruangkanchanasetr S, Suepiantham J, Tapsart C, Sangsajja C. Blood lead level in Bangkok children. J Med Assoc Thai. 1999 Nov;82 Suppl 1:S154–61.
Ruangkanchanasetr S, Suepiantham J. Risk factors of high lead level in Bangkok children. J Med Assoc Thai. 2002 Nov;85 Suppl 4:S1049–58.
Ecological Alert and Recovery - Thailand (EARTH); International Pollutants Elimination Network. Lead in playground equipment in Thailand [Internet]. [place unknown]: International Pollutants Elimination Network; 2019 Oct [cited 2023 Mar 5]. <https://ipen.org/documents/lead-playground-equipment-thailand>
Khan DA, Qayyum S, Saleem S, Ansari WM, Khan FA. Lead exposure and its adverse health effects among occupational worker's children. Toxicol Ind Health. 2010;26(8):497–504. doi:10.1177/0748233710373085.
Roscoe RJ, Gittleman JL, Deddens JA, Petersen MR, Halperin WE. Blood lead levels among children of lead-exposed workers: A meta-analysis. Am J Ind Med. 1999 Oct;36(4):475–81. doi:10.1002/(sici)1097-0274 (199910)36:4<475::aid-ajim9>3.0.co;2-o.
Abbritti G, Cicioni C, Gambelunghe M, Fiordi T, Accattoli MP, Morucci P, et al. Blood lead levels in children living in three communities, at different risks of lead pollution. Biomed Environ Sci. 1988 Dec;1(4):363–71.
Zhang F, Liu Y, Zhang H, Ban Y, Wang J, Liu J, et al. Investigation and Evaluation of Children's Blood Lead Levels around a Lead Battery Factory and Influencing Factors. Int J Environ Res Public Health. 2016 May 28;13(6):541. doi:10.3390/ijerph13060541.
Magan C. Workers at Federal Ammunition in Anoka urged to test for lead exposure [Internet]. Saint Paul (MN): Pioneer Press; 2023 Feb 10 [cited 2023 Mar 5]. <https://www.twincities.com/ 2023/02/10/workers-at-federal-ammunition-in-anoka-urged-to-test-for-lead-exposure/>
Yimthiang S, Waeyang D, Kuraeiad S. Screening for elevated blood lead levels and related risk factors among Thai children residing in a fishing community. Toxics. 2019 Oct 12;7(4):54. doi:10.3390/toxics7040054.
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