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BACKGROUND: Lead poisoning can lead to a wide spectrum of adverse effects which are permanent and irreversible. In 2012, nearly 900 children and over 100 adults in Colorado exceeded the CDC blood lead reference levels. Surveillance is important in identifying lead poisoning cases to reduce future exposure to lead. The purpose of this evaluation was to ensure that lead poisoning is being monitored efficiently and effectively in Colorado.
METHODS: We interviewed the key surveillance system stakeholders. Using the qualitative data gathered from the interviews, we described the following system attributes: simplicity, flexibility, acceptability, timeliness, and stability. In addition, we collected quantitative data from 2010 and 2013 cases to describe the system’s data quality and representativeness. To meet the current case definition, a child’s first capillary blood lead result must be confirmed by a second test. We will determine the positive predictive value of the first elevated capillary blood test in children. This positive predictive value will be used to describe the sensitivity of the system.
RESULTS: The surveillance system is a complex set of multiple databases which require a lot of time-intensive manual data entry and cleaning. Though, the manual nature of the system allows flexibility. It is simple to change almost any aspect of the system. Generally, the system is well accepted. All child blood lead tests and elevated adult blood lead tests are reportable in Colorado. The local public health agencies value the information they receive from the system, but would like it to be a two-way system of communication. The timeliness of the system is not known as date of notification to the local public health agency is not recorded. The system is generally stable even though funding for the system generally has not been. Despite the lack of consistent funding, any issue with the system is usually quickly corrected. Data quality after cleaning is high for age and sex variables with less than 1% and 3%, respectively, of records missing that information. Data quality for address is lower. Over 10% of records did not have enough information to assign county of residence.
CONCLUSIONS: There are many potential improvements to the lead poisoning surveillance system. The most essential ones are to simplify the data cleaning process and improve the collection of data related to the system’s performance. The recent funding of Colorado’s Childhood Lead Poisoning Prevention Program can provide resources to make some of these needed improvements.