Missouri Adult Blood Lead Surveillance and Epidemiology Program Annual Report

(*Preliminary)

January 1, 2002 through December 31, 2002

The Centers for Disease Control and Prevention (CDC), National Institute of Occupational Safety and Health (NIOSH) has funded states to operate the Adult Blood Lead Surveillance and Epidemiology (ABLES) program since 1987. The goal of this program is the elimination of all cases of workplace-induced lead elevations >25 mg/dl in adults by the year 2010. States collect and analyze data on cases of elevated blood lead levels in individuals age 16 years and older. The majority of lead elevat ions in this population are believed to be due to exposures in the workplace. Non-identifying data is reported by each state to NIOSH for national surveillance purposes.

The Missouri Department of Health and Senior Services, Office of Surveillance first received funding from NIOSH in Fall 2001 to collect and report ABLES data. This preliminary report summarizes calendar year 2002 data. Records with incomp lete data, particularly age and county of residence, will be re-analyzed by the Missouri ABLES (MO ABLES) program when the missing information is obtained.

There were 14,171 blood specimens drawn, analyzed, and reported to the MO ABLES program for individuals age 16 years and older between January 1, 2002 and December 31, 2002. Blood specimens drawn but not analyzed are excluded. 2,130 adult s were tested more than once during the year.

Analysis of the Missouri ABLES data revealed 8,407 unduplicated individuals were tested in 2002. Blood lead level determination is based upon their highest reported blood lead level during the 2002 time frame. Of these, 7,474 (88.9%) had lead levels <25 mg/dl. There were 818 (9.7%) reported with lead levels between 25 mg/dl and 39 mg/dl, and 115 (1.4%) were people whose highest level was 40 mg/dl or above.

In total during 2002, 933 (11.1%) of all individuals tested had at least one blood lead test at or above 25 mg/dl, the CDC's lead level of concern for non-pregnant adults. See Figure 1.

*This report is preliminary, pending receipt of additional information.

The MO ABLES program data is primarily collected from laboratory reporting. The Missouri disease reporting rule, 19 CSR 20-20.080 requires laboratories to report to the state or local health authority all blood lead test results for Missou ri residents. Information is to include patient date of birth or age, home address, gender, race, ethnicity, date of blood lead test, and laboratory results. Despite this regulation, laboratory data often does not include all information needed and desi red. Missing information on individuals with blood lead levels >25 mg/dl is sought by telephone calls to medical providers and employers; therefore, data on non-elevated adults is more likely to be incomplete in the MO ABLES database.

The following data analyses were performed on a data set consisting only of the 933 individuals with at least one blood lead level >25 mg/dl during 2002.

Of the 933 elevated adults in 2002, the MO ABLES program had date of birth or age information on 659 (70.6%). Of individuals with a known age, there were 654 (99.2%) between 18 and 64 years of age at the time their blood specimen was draw n. There were 4 (0.4%) adults in the age range of 65 through 74 years, and only 1 (0.1%) person more than 74 years old. During this time frame, there were no 16 or 17 year-olds with an elevated lead level. Age was not known for 274 (29.4%) of individuals with lead levels >25 mg/dl. See Figure2. Date of birth and/or age on incomplete records has been requested.

Figure 3 illustrates that 821 (88.0%) adults with elevated lead levels were male, females comprised 73 (7.8%), and 39 (4.2%) were unknown.

Race and ethnicity information is sought for all elevated adults. When contacted, MO ABLES staff find that many medical providers and employers do not have this information available about their patients and workers. For the 230 individua ls with a reported race, 222 (96.5%) were white, 6 (2.6%) were black, and 2 (0.9%) were Native American or Alaskan Native. None were reported as Asian or Pacific Islander. Of 231 elevated adults with a reported ethnicity, 226 (97.8%) were Non-Hispanic a nd 5 (2.2%) were Hispanic. However, as indicated in Figures 4 and 5, race and ethnicity are not known for the majority of adults with elevated lead levels.

Of the 933 individual records with blood lead levels >25 mg/dl drawn in 2002, 916 (98.2%) have a known employer and Standardized Industry Code (SIC). Five industries represented 842 (91.9%) of these workers. The industries with the larges t numbers of lead-elevated employees are shown in Figures 6 and 7. A worker's place of employment is assumed to be their source of exposure unless other source information, such as an exposure by hobby, is received.

Lead battery manufacturing, mining, smelting, and other related industries are an important part of Missouri's economic base. Some of the world's largest known lead deposits are located in Missouri, and mining has been ongoing since the 17 00s. While lead is a great economic resource, lead in the human body is a health hazard. Missouri's largest lead industries provide community education and services, as well as testing their employees regularly for lead elevations. These companies also cooperate in providing demographic information to aid the MO ABLES program in data collection.

There were 13 elevated worker records missing an identifiable employer or SIC code, but for whom an occupation or other source was known. These sources included renovating an old home (4), repairing radiators (4), painting (2), refurbishin g stained glass windows (1), using firearms (1), and melting lead for fishing weights (1). Employment or source information on 4 workers was not available.

The MO ABLES database includes 783 (83.9%) records with a known county of employment for the 933 workers with a blood lead elevation. The majority of these workers are employed in the metropolitan and southern areas of Missouri, although t here are 56 (7.2%) working in an adjacent Kansas county. See map in Appendix A.

Particularly in rural areas of Missouri, workers commute across county boundaries to reach their places of employment. Analysis of this trend is impaired because laboratory data often does not include a worker's home address. Of the 783 e levated workers for 2002 with a known county of employment, only 392 (50.1%) included a county of residence. The MO ABLES program has requested home address information for those workers with a known employer.

Workers who are employed out of state are included in MO ABLES if they are known to reside in Missouri. In the 2002 data set there were 917 workers whose address of employment was known. Of these 917, there were 56 (6.1%) Missouri residen ts with elevated blood lead levels who were employed in Kansas, 17 (1.9%) in Iowa, 2 (0.2%) in Illinois, and 1(0.1%) in Oklahoma. The remaining 841 (91.7%) elevated workers are employed in the state of Missouri.

The MO ABLES program plans to expand its scope in the future, as funding and personnel resources allow. Planned future program activities include:

• data linkages with the Missouri Childhood Lead Poisoning Prevention Program;
• data linkages with other heavy metal poisonings including: cadmium, arsenic, and mercury;
• more timely and complete data collection, particularly for workers reported with elevated lead levels;
• enhanced Geographical Information Services (GIS) analyses on existing data;
• development of a Missouri ABLES Internet site for public information and education; and
• dissemination of lead poisoning prevention education to workers not receiving information from their employer.

link to NIOSH ABLES