Adult Blood Lead Epidemiology and Surveillance -- United States, First Quarter 1996, and Annual 1995

CDC's National Institute for Occupational Safety and Health Adult Blood Lead Epidemiology and Surveillance program (ABLES) monitors laboratory-reported elevated blood lead levels (BLLs) among adults in the United States (1). Twenty-three states reported surveillance results to the ABLES program in 1995. Ohio and Minnesota joined ABLES in 1996; their data are included for the first quarter of 1996. This report presents ABLES data for the first quarter of 1996 compared with the first quarter of 1995 and annual data for 1995 compared with 1994. First Quarter Reports, 1996

During January 1-March 31, 1996, the number of reports of BLLs greater than or equal to 25 ug/dL decreased by 8% compared with the number reported for the same period in 1995 (2), which has been revised to include previously unpublished 1995 data for Minnesota and Ohio (Table_1). The number of reports for 1996 decreased in all reporting categories. This overall trend of decreasing reports is consistent with the fourth quarter report for 1995 (3). Annual Reports, 1995

Overall reports of BLLs greater than or equal to 25 ug/dL decreased from 26,832 in 1994 to 26,459 in 1995 (Table_2); this represents a 1% decrease, with the same 23 states reporting in each year. In comparison, the number of reports increased by 4% from 1993 to 1994; however, three additional states had initiated reporting in 1994 (2). Although total reports decreased in 1995, the number of reported persons with BLLs greater than or equal to 25 ug/dL increased from 12,137 in 1994 to 12,664 in 1995 * (Table_2), representing a 4% increase (with a constant 23 states reporting). Similarly, from 1993 to 1994, the number of persons with BLLs greater than or equal to 25 ug/dL increased 8%, with three new states starting to report in 1994 (2). Finally, the proportion of reported persons with new cases ** decreased by 11% from 1994 to 1995 (Table_2); this followed a 15% decrease from 1993 to 1994 (2). Of the 12,664 persons reported in 1995, 4993 (39%) had new cases (Table_2); in comparison, of the 12,137 persons reported in 1994, 5619 (46%) had new cases, and of the 11,240 reported in 1993, 6584 (59%) had new cases (2).

The proportion of BLLs reported to ABLES at greater than or equal to 50 ug/dL (the level designated by the Occupational Safety and Health Administration for medical removal from the workplace) was 8% in 1993, 6% in 1994 (2), and 5% in 1995. The proportion of persons with BLLs at the greater than or equal to 50 ug/dL level was 8% in 1993, 8% in 1994 (2), and 5% in 1995. The proportion of new cases reported to ABLES at the greater than or equal to 50 ug/dL level was 9% in 1993, 9% in 1994 (2), and 6% in 1995.

Reported by: JP Lofgren, MD, Alabama Dept of Public Health. C Fowler, MS, Arizona Dept of Health Svcs. S Payne, MA, Occupational Lead Poisoning Prevention Program, California Dept of Health Svcs. BC Jung, MPH, Connecticut Dept of Public Health. M Lehnherr, Occupational Disease Registry, Div of Epidemiologic Studies, Illinois Dept of Public Health. R Gergely, Iowa Dept of Public Health. A Hawkes, MD, Occupational Health Program, Maine Bur of Health. E Keyvan-Larijani, MD, Lead Poisoning Prevention Program, Maryland Dept of the Environment. R Rabin, MSPH, Div of Occupational Hygiene, Massachusetts Dept of Labor and Industries. M Scoblic, MN, Michigan Dept of Public Health. M Falken, PhD, Minnesota Dept of Health. L Thistle-Elliott, MEd, Div of Public Health Svcs, New Hampshire State Dept of Health and Human Svcs. B Gerwel, MD, Occupational Disease Prevention Project, New Jersey Dept of Health. R Stone, PhD, New York State Dept of Health. S Randolph, MSN, North Carolina Dept of Environment, Health, and Natural Resources. 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. R Marino, MD, Div of Health Hazard Evaluations, South Carolina Dept of Health and Environmental Control. P Schnitzer, PhD, 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. J Kaufman, MD, Washington State Dept of Labor and Industries. V Ingram-Stewart, MPH, Wisconsin Dept of Health and Social Svcs. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: During 1993-1995, the decreases in the number of reports of BLLs greater than or equal to 25 ug/dL and the proportions of new cases may reflect improved efforts of the various participating states, and lead-using industries within them, to identify lead-exposed workers and prevent new lead exposures. However, the number of persons with BLLs greater than or equal to 25 ug/dL increased, and 61% of the persons reported with BLLs greater than or equal to 25 ug/dL in 1995 also had been reported in 1994. Reasons for repeat reports of elevated BLLs include 1) recurring exposure resulting from inadequate control measures and worker-protection practices, which may indicate a need for strengthened prevention measures; 2) routine retesting of employee BLLs that, although elevated, remain below levels requiring medical removal; and 3) increased employer monitoring during medical removal. All the trends in BLLs greater than or equal to 50 ug/dL seem to be consistent with improved worker protection.

Trends in these surveillance data must be interpreted in relation to variations in annual reporting totals, which reflect 1) changes in the number of participating states; 2) changes in staffing and funding in state-based surveillance programs; and 3) interstate differences in worker BLL testing by lead-using industries. In addition, estimates from the Third National Health and Nutrition Examination Survey of the number of adults exposed to lead (4) indicate that ABLES data may be underreported.

The findings in this report document the continuing occurrence of work-related lead exposures as an occupational health problem in the United States. A goal of the ABLES program is to enhance surveillance for this preventable condition by expanding the number of participating states, reducing variability in reporting, and distinguishing between new and recurring elevated BLLs in adults.

References

1. CDC. Surveillance of elevated blood lead levels among adults -- United States, 1992. MMWR 1992;41:285-8.

2. CDC. Adult Blood Lead Epidemiology and Surveillance -- United States, 1994 and first quarter, 1995. MMWR 1995;44:515-7.

3. CDC. Adult Blood Lead Epidemiology and Surveillance -- United States, fourth quarter, 1995. MMWR 1996;45:333-4.

4. 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.

* Persons often have multiple elevated BLLs reported in a given year. Individual reports for persons are categorized according to the highest reported BLL for the person during the given quarter. 

** A new case is defined as at least one report of a BLL greater than or equal to 25 ug/dL in an adult that appears in state surveillance data during the current year and was not recorded in the immediately preceding year. Based on this definition, in the year a state begins surveillance, all persons are new cases; as surveillance continues into subsequent years, repeating persons are no longer counted as new cases. Thus, a decrease in the proportion of new cases may be explained in part by removal of reports from the "new case" category as a state enters its second year of reporting.

TABLE 1. Number of reports of elevated blood lead levels (BLLs) among adults,
number of adults with elevated BLLs, and percentage change in number of
reports -- 25 states, * first quarter, 1996
==============================================================================
                 First quarter, 1996       No. reports,   % Change from
Reported BLL  -------------------------   first quarter,   first quarter,
  (ug/dL)     No. reports  No. persons +      1995 &        1995 to 1996
------------------------------------------------------------------------------
25-39             4954         3612           5236            - 5%
40-49             1152          819           1313            -12%
50-59              207          154            282            -27%
 >=60              102           54            108            - 6%
Total             6415         4639           6939            - 8%
------------------------------------------------------------------------------
* Reported by Alabama, Arizona, California, Connecticut, Illinois, Iowa,
  Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire,
  New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania,
  South Carolina, Texas, Utah, Vermont, Washington, and Wisconsin.
+ Individual reports for persons are categorized according to the highest
  reported BLL for the person during the given quarter. Pennsylvania provides
  the number of reports but no information on persons. The data about persons
  for Pennsylvania included in this table are estimates based on the
  proportions from the other 24 states combined and the number of reports
  received from Pennsylvania. Data for Alabama and Arizona were missing; first
  quarter 1995 data were used as an estimate.
& Unpublished data for Ohio and Minnesota are included for the first time in
  addition to previously published 1995 totals (2).
==============================================================================

TABLE 2. Number of reports of elevated blood lead levels (BLLs) among adults,
number of adults with elevated BLLs, and new cases of elevated BLLs -- United
States, + 1994 and 1995
===============================================================================
                            1995                            1994
              --------------------------------  -------------------------------
                                   New cases @                     New cases ++
Highest BLL      No.       No.    ------------    No.      No.     ------------
  (ug/dL)     reports & persons @  No.    (%)   reports  persons   No.    (%)
-------------------------------------------------------------------------------
25-39          19,979    9,586    3,780  (39)    19,420   8,651   4,254  (49)
40-49           5,125    2,399      894  (37)     5,821   2,562     887  (35)
50-59             911      447      176  (39)     1,132     644     269  (42)
 >=60 &           444      232      143  (62)       459     280     209  (75)
Total          26,459   12,664    4,993  (39)    26,832  12,137   5,619  (46)
-------------------------------------------------------------------------------
*  A new case is defined as at least one report of a BLL >=25ug/dL in an adult
   that appears in state surveillance data during the current year and was not
   recorded in the immediately preceding year. Based on this definition, in the
   year a state begins surveillance, all persons are new cases; as surveillance
   continues into subsequent years, repeating persons are no longer counted as
   new cases. Thus, a decrease in the proportion of new cases may be explained
   in part by removal of reports from the "new case" category as a state enters
   its second year of reporting.
+  Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maine, Maryland,
   Massachusetts, Michigan, New Hampshire, New Jersey, New York, North
   Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Utah,
   Vermont, Washington, and Wisconsin.
&  Data for Alabama and Vermont were missing for 1995; 1994 data were used as
   an estimate.
@  Individual reports are categorized according to the highest reported BLL
   for the person during the given year. Pennsylvania and Michigan provided
   number of reports but not persons; the number of persons are estimates
   based on the proportions from the other 21 states combined and the number
   of reports received from the two states. Data for Alabama and Vermont were
   missing for 1995; 1994 data were used as an estimate.
** New cases for 1995 were not reported for Illinois, Michigan, Pennsylvania,
   and South Carolina. New cases for those four states are estimates based on
   proportions from the other 19 states combined and the number of reports,
   persons, or unassigned new cases reported from the four states. Data for
   Alabama, New Hampshire, and Vermont were missing for 1995; 1994 data were
   used as an estimate.
++ New cases for 1994 were not reported from Illinois, Michigan, Pennsylvania,
   and South Carolina. Estimates were included in the 1994 data.
===============================================================================

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