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Alex R. Kemper, MD, MPH, MS; Lisa M. Cohn, MS; Kathryn E. Fant, MPH; Kevin J. Dombkowski, DrPH; Sharon R. Hudson, RN, MSN, CNM

JAMA. 2005;293:2232-2237.

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.

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).

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