Adult Blood Lead Epidemiology and Surveillance -- United States, Second and Third Quarters, 1998, and Annual 1994-1997

Chronic lead exposure in adults can damage the cardiovascular, central nervous, renal, reproductive, and hematologic systems. CDC's Adult Blood Lead Epidemiology and Surveillance (ABLES) program monitors laboratory-reported elevated blood lead levels (BLLs) among adults in the United States. During 1998, 27 states * reported surveillance data to ABLES. This report presents prevalence data for elevated BLLs for the second and third quarters of 1998 and compares them with corresponding quarters of 1997, and presents annual prevalence data for elevated BLLs from 1994 through 1997 for each participating state. The findings indicate that of the approximately 20,000 persons tested for blood lead and reported to ABLES each quarter, approximately 4000 BLLs were elevated. The 1994-1997 prevalence rates of elevated BLLs among adults provide a crude comparison of the levels and trends among the 27 states participating in the program.

ABLES defines an adult as a person aged greater than or equal to 16 years and an elevated BLL in an adult as greater than or equal to 25 ug/dL, although BLL reporting thresholds vary among the states. Persons with duplicate BLL tests are included once per quarter and once per year at the highest BLL for that person. Denominators for calculating prevalence during 1994-1997 are the population figures (aged 16-64 years) of the individual participating states (1). An upper age cutoff of 64 years is used because 90%-95% of adult lead exposures occur at work. Not all of the current 27 ABLES states reported data over the entire period from 1994 through 1997.

Second Quarter, 1998

During April 1-June 30, 1998, of the 20,212 adults for whom BLLs were reported by the states, 3727 (18%) had levels greater than or equal to 25 ug/dL, a 14% decrease compared with the 4335 reported for the second quarter of 1997 (2) and a 12% decrease compared with the 4243 reported for the first quarter of 1998 (3) (Figure_1). Of the 3727, 182 (5%) were reported with BLLs greater than or equal to 50 ug/dL (the Occupational Safety and Health Administration {OSHA} level for medical removal from the workplace {4}), an 8% decrease compared with 197 reported for the second quarter of 1997 (2) and a 4% increase compared with 175 reported for the first quarter of 1998 (3).

Third Quarter, 1998

During July 1-September 30, 1998, of the 20,511 adults for whom BLLs were reported by the participating states, 3322 (16%) had BLLs greater than or equal to 25 ug/dL, a 21% decrease compared with 4180 persons reported for the third quarter of 1997 (5) and an 11% decrease compared with 3727 reported for the second quarter of 1998 (Figure_1). Of the 3322, 182 (6%) were reported with BLLs greater than or equal to 50 ug/dL, a 13% decrease compared with 209 reported for the third quarter of 1997 (5) and an equal number compared with the second quarter of 1998.

Annual ABLES Prevalence, 1994-1997

The prevalence of adults with BLLs greater than or equal to 25 ug/dL per million adults aged 16-64 years varied among the participating states for 1994 through 1997 (Figure_2). These rates ranged from 15 per million for Arizona (1994) to 442 per million for Pennsylvania (1997). Michigan, New Mexico, Rhode Island, and Wyoming began reporting in 1997; Ohio and Minnesota began reporting in 1996; and Illinois last reported in 1996.

Reported by: JP Lofgren, MD, Alabama Dept of Public Health. K Schaller, Arizona Dept of Health Svcs. S Payne, MA, Occupational Lead Poisoning Prevention Program, California Dept of Health Svcs. BC Jung, MPH, Div of Environmental Epidemiology and Occupational Health, Connecticut Dept of Public Health. R Gergely, Iowa Dept of Public Health. W Davis, MPA, Occupational Health Program, Bur of Health, Maine Dept of Human Svcs. E Keyvan-Larijani, MD, Lead Poisoning Prevention Program, Maryland Dept of Environment. R Rabin, MSPH, Div of Occupational Safety, Massachusetts Dept of Labor and Workforce Development. A Allemier, Dept of Medicine, Michigan State Univ, East Lansing. M Falken, PhD, Minnesota Dept of Health. C DeLaurier, Div of Public Health Svcs, New Hampshire State Dept of Health and Human Svcs. B Gerwel, MD, Occupational Disease Prevention Project, New Jersey State Dept of Health. R Prophet, PhD, New Mexico Dept of Health. R Stone, PhD, New York State Dept of Health. S Randolph, MSN, North Carolina Dept of Health and Human Svcs. A Migliozzi, MSN, Bur of Health Risk Reduction, Ohio Dept of Health. E Rhoades, MD, Oklahoma State Dept of Health. A Sandoval, MS, State Health Div, Oregon Dept of Human Resources. J Gostin, MS, Occupational Health Program, Div of Environmental Health, Pennsylvania Dept of Health. M Stoeckel, MPH, Rhode Island Dept of Health. A Gardner-Hillian, Div of Health Hazard Evaluations, South Carolina Dept of Health and Environmental Control. D Salzman, MPH, Bur of Epidemiology, Texas Dept of Health. W Ball, PhD, Bur of Epidemiology, Utah Dept of Health. L Toof, Div of Epidemiology and Health Promotion, Vermont Dept of Health. P Rajaraman, MS, Washington State Dept of Labor and Industries. J Tierney, Wisconsin Dept of Health and Family Svcs. T Klietz, Wyoming Dept of Health. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The symptoms of adult lead poisoning include fatigue, irritability, insomnia, and headaches. Occupations known to expose workers to lead include radiator repair, battery manufacture and recycling, smelting, and construction or remodeling involving lead-based paint. Lead exposure can be prevented by engineering controls, good housekeeping, personal protective equipment, and fastidious hygiene. Medical removal from a lead-exposed job is required by OSHA when a workers' BLL is greater than or equal to 50 ug/dL.

Second quarter data for 1997 through the first quarter of 1998 indicate that the number of persons with BLLs greater than or equal to 25 ug/dL reported by participating states was approximately 4000 per quarter. An apparent decrease in the number of persons with BLLs greater than or equal to 25 ug/dL occurred in both the second and third quarters of 1998. Furthermore, the testing level has remained relatively constant, indicating that the decrease probably is not caused by the performance of fewer BLL tests. However, amendments to previous quarterly reports are likely to occur when fourth quarter reports are received. These amendments occur because ABLES is concerned with the diagnosis date of the blood lead laboratory report and not the date the laboratory result was received by the state health department. Therefore, additional data collected through ABLES are needed to interpret the current quarterly data and their implications for projecting trends.

State-specific prevalences presented in this report may not accurately reflect workplace lead exposures because not all employers tested lead-exposed employees for elevated BLLs and not all laboratories reported results. For example, data from the National Health and Nutrition Examination Survey (NHANES III, 1988-1991) (6,7) predicted approximately 700,000 adults with BLLs greater than or equal to 25 ug/dL in the entire United States; ABLES data, adjusted for a national estimate, predicted approximately 18,000 persons with BLLs greater than or equal to 25 ug/dL in 1994. In addition, the denominators for the prevalence rates are the respective state populations aged 16-64 years, but the percentage of working persons in this age group who were reported to be exposed to lead is unknown and varies from state to state.

All ABLES data are subject to certain limitations and, as with state-specific prevalence data, may not convey a true picture of workplace lead exposure. Variation in the number of persons with BLLs greater than or equal to 25 ug/dL reported quarterly and annually to ABLES may reflect changes in 1) the year-to-year efforts of participating states and lead-using industries within them to identify lead-exposed workers and to prevent new exposures; 2) occupational exposures to lead; 3) compliance with OSHA requirements regarding blood lead monitoring; and 4) workforce size in lead-using industries. Variations in quarterly and annual nationwide reporting totals might represent normal fluctuations in case reporting, which might result from changes in staffing and funding in state-based surveillance programs, interstate differences in worker BLL testing by lead-using industries, or random variations. Individual state contributors must be consulted for accurate interpretations of state-specific prevalences and trends.

The findings in this report document the continuing hazard of lead exposure as an occupational health problem in the United States. ABLES enhances surveillance for this preventable condition by increasing the number of participating states, exploring ways to increase the usefulness of reporting, and alerting the public to potential new sources of lead.

References

1. Bureau of the Census, Economic and Statistics Administration, US Department of Commerce. Population estmates. Available at . Accessed March 1999.

2. CDC. Adult blood lead epidemiology and surveillance -- United States, second quarter, 1997. MMWR 1997;46:1000-2.

3. CDC. Adult blood lead epidemiology and surveillance -- United States, first quarter, 1998 and annual 1994-1997. MMWR 1998;47:907-11.

4. US Department of Labor, Occupational Safety and Health Administration. Final standard for occupational exposure to lead. Federal Register 1978;43:52952-3014 (29 CFR 1910.1025).

5. CDC. Adult blood lead epidemiology and surveillance -- United States, third quarter, 1997. MMWR 1998;47:77-80.

6. Pirkle JL, Brody DJ, Gunter EW, et al. The decline in blood lead levels in the United States: the National Health and Nutrition Examination Surveys (NHANES). JAMA 1994;272:284-91.

7. Brody DJ, Pirkle JL, Kramer RA, et al. Blood lead levels in the US population: phase 1 of the third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991). JAMA 1994;272:277-83.

Alabama, Arizona, California, Connecticut, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, Wisconsin, and Wyoming.

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