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Kemper AR, Cohn LM, Fant KE, Dombkowski KJ, Hudson SR. Follow-up Testing Among Children With Elevated Screening Blood Lead Levels. JAMA. 2005;293(18):2232–2237. doi:10.1001/jama.293.18.2232
Author Affiliations: Child Health Evaluation
and Research Unit, Division of General Pediatrics, University of Michigan,
Ann Arbor (Drs Kemper and Dombkowski and Mss Cohn and Fant); and Childhood
Lead Poisoning Prevention Program, Michigan Department of Community Health,
Lansing (Ms Hudson).
Context Follow-up testing after an abnormal screening blood lead level is a
key component of lead poisoning prevention.
Objectives To measure the proportion of children with elevated screening lead levels
who have follow-up testing and to determine factors associated with such care.
Design, Setting, and Participants Retrospective, observational cohort study of 3682 Michigan Medicaid-enrolled
children aged 6 years or younger who had a screening blood lead level of at
least 10 μg/dL (0.48 μmol/L) between January 1, 2002, and June 30, 2003.
Main Outcome Measure Testing within 180 days of an elevated screening lead level.
Results Follow-up testing was received by 53.9% (95% confidence interval [CI],
52.2%-55.5%) of the children. In multivariate analysis adjusting for age,
screening blood lead level results, and local health department catchment
area, the relative risk of follow-up testing was lower for Hispanic or nonwhite
children than for white children (0.91; 95% CI, 0.87-0.94), for children living
in urban compared with rural areas (0.92; 95% CI, 0.89-0.96), and for children
living in high- compared with low-risk lead areas (0.94; 95% CI, 0.92-0.96).
Among children who did not have follow-up testing, 58.6% (95% CI, 56.3%-61.0%)
had at least 1 medical encounter in the 6-month period after the elevated
screening blood lead level, including encounters for evaluation and management
(39.3%; 95% CI, 36.9%-41.6%) or preventive care (13.2%; 95% CI, 11.6%-14.8%).
Conclusions The rate of follow-up testing after an abnormal screening blood lead
level was low, and children with increased likelihood of lead poisoning were
less likely to receive follow-up testing. At least half of the children had
a missed opportunity for follow-up testing. The observed disparities of care
may increase the burden of cognitive impairment among at-risk children.
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