BACKGROUND: Targeted testing of young children at risk for lead exposure can aid primary prevention efforts. California requires lead testing for children with Medicaid. We examined associations between sociodemographic characteristics, blood lead testing, and elevated blood lead levels (EBLLs). We defined EBLLs to be ≥4.5 µg/dL, which when rounded up per California’s criteria is consistent with the Centers for Disease Control and Prevention’s recommended reference level of 5 µg/dL.
METHODS: We identified Kaiser Permanente Southern California members aged 6–30 months during 2008–2015, their characteristics, and their lead tests from electronic health records. We used multivariable log-binomial regression to assess associations with testing and logistic regression to assess associations with EBLLs. Models included birth year, sex, race/ethnicity, Medicaid status, and neighborhood deprivation index (NDI).
RESULTS: We identified 292,235 children. Approximately half were female, and one-fifth received Medicaid. Among 169,064 children tested, 158,840 (94.0%) had blood lead levels <2 µg/dL, 8,968 (5.3%) had blood lead levels between 2–4.4 µg/dL, and 1,256 (0.7%) had EBLLs. Compared with not receiving Medicaid, receiving Medicaid was associated with testing (67.6% versus 54.4%, relative risk [RR]: 1.12; 95% confidence interval [CI]: 1.11–1.13) and EBLLs (0.9% versus 0.7%, odds ratio [OR]: 1.16; 95% CI: 1.02–1.32). Compared with being in the lowest NDI quartile (least deprived), being in the highest quartile was associated with testing (65.4% versus 48.3%, RR: 1.18; 95% CI: 1.17–1.19) and EBLLs (0.9% versus 0.4%, OR: 1.56; 95% CI: 1.29–1.88).
CONCLUSIONS: The positive association between Medicaid and EBLLs supports California’s requirement of testing Medicaid-insured children. Residence in disadvantaged neighborhoods is associated with EBLLs and can guide targeted lead-screening programs for young children.