In October, the Centers for Disease Control and Prevention lowered its blood lead level threshold. Under the new guidance, the Allegheny County Health Department estimates more than 500 Allegheny County kids will be considered to have an elevated level of lead in their blood.
The new threshold is, in a way, good news. The CDC’s blood lead reference value is meant to identify kids whose blood lead level is in the top 2.5% among U.S. children. The old threshold was 5 micrograms per deciliter. But as lead levels have fallen across the country, the new threshold was updated to 3.5 micrograms per deciliter.
“Nationally, rates have gone down for elevated blood lead levels. Locally, they have, [too],” said LuAnn Brink, chief epidemiologist for the Allegheny County Health Department. “And that’s why we’re in this new situation because the top 2.5[%] are lower than they were 10 years ago.”
But the new threshold means a big increase in the number of Allegheny County kids whose blood levels are considered elevated, after several years of steady declines.
In 2018, Allegheny County enacted a universal blood lead testing policy, requiring young children to be tested for lead. In the first year of expanded testing, 481 kids under six years old had an elevated blood lead level of 5 micrograms per deciliter or above. By 2020, that number had dropped to 341.
Brink says that based on 2020 data, she estimates an additional 200 kids will have an elevated blood lead level based on the new 3.5 microgram per deciliter threshold. That would bring the total number of kids with elevated blood lead level to over 500.
“Certainly it’s something that we have to think about as far as providing any resources to the additional kids who would now be referred to as a child with a level of concern,” Brink said.
No level of lead exposure in children is safe. Even low levels, below the CDC threshold, have been shown to have negative cognitive and behavioral impacts—and Black and brown people are disproportionately exposed. In 2019, in Allegheny County, 4% of Black children under six years old had an elevated blood lead level; 3% of Hispanic children; and 1% of white children.
ACHD’s main intervention when a child has an elevated blood lead level is its free home lead investigation program. Under the program, an inspector tests painted surfaces for lead and takes samples of water, dust and soil. The family receives a report with results and recommendations.
Brink credits the combined universal testing and free home lead inspection programs with the decrease in blood lead levels among Allegheny County kids in recent years.
“Every time that we catch those kids and get them into the intervention with our housing program, we help the situation a bit more,” Brink said.
Brink says the health department doesn’t yet know when they’ll have the resources to offer home lead investigations to families with children meeting the new threshold.
The last time the CDC updated its guidance was 2012, when they changed the threshold from 10 micrograms per deciliter to 5 micrograms per deciliter. ACHD wasn’t able to offer free home lead investigations for kids with blood levels at that threshold until 2018.
