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BACKGROUND: Lead exposures in adults can result in acute and chronic health effects, and exposures are often work-related. In Nebraska, blood lead laboratory tests are automatically entered into Nebraska’s Electronic Disease Surveillance System (NEDSS) via electronic laboratory reporting. For many blood lead tests, address and race information are not reported, despite the requirement in reportable disease regulations. Missing demographic information limits our ability to assess the epidemiological and geographical risk of adult lead exposures. The purpose of this study was to use data linkage to increase completeness of demographic information in order to describe elevated lead levels in Nebraska.
METHODS: We linked 11,788 blood lead laboratory tests from NEDSS with the Nebraska’s drivers’ license database so that address of residence and race information could be retrieved. Blood lead tests conducted between 2008 and 2012 were included for individuals aged 16 years or older. The date linkage was carried out via LinkPlus using a probabilistic method based on individuals’ name, gender, birthdate, and zip code as matching variables. Cases were defined as a blood lead level ≥10 μg/dL and were based on the individual’s highest blood lead test in a given year. Cases are described by characteristics such as age, race, county, and industry.
RESULTS: Data linkage increased the completeness of residence information from 57% to 83% and increased race information from 18% to 85% among all linked tests. From 2008 to 2012, 368 individuals with a new blood lead test ≥10 μg/dL were identified. Incident cases occurred more frequently in men (91%) and in individuals 25–34 years old (30%). Among 219 cases with known race information, 82% were among individuals identified as white. The majority of individuals (63%) resided in just six counties, and the primary metals manufacturing subsector was the most frequently reported industry (61%).
CONCLUSIONS: Using data linkage to improve completeness of demographic information for blood lead tests helps us identify the epidemiological and geographical risk of lead poisoning among adults. Our results indicate adult lead exposures continue to be a public health problem in Nebraska. Many of the elevated blood lead cases were restricted to small number of counties, which allows us to better focus lead poisoning prevention efforts in these areas. Despite improvements through data linkage, gaps still remain in completeness of demographic information. Continued surveillance efforts are needed in Nebraska to capture adequate epidemiological information for adults with elevated lead levels.