Adult Blood Lead Epidemiology and Surveillance -- United States, First Quarter 1997, and Annual 1996

CDC's National Institute for Occupational Safety and Health Adult Blood Lead Epidemiology and Surveillance (ABLES) program monitors laboratory-reported elevated blood lead levels (BLLs) among adults in the United States. Data for New Mexico, Rhode Island, and Wyoming are included for the first time in this report, increasing the number of reporting states to 27 (Illinois discontinued reporting at the end of 1996). Twenty-five states reported surveillance data to the ABLES program in 1996. * This report presents ABLES data for the first quarter of 1997 compared with the first quarter of 1996 and annual data for 1996 compared with 1995. The findings from 1995 and 1996 indicate a continuing decrease in the annual number of persons reported with elevated BLLs, although the number of reports in the first quarter of 1997 were higher than that for the same period in 1996. First Quarter Reports, 1997

During January 1-March 31, 1997, the number of reports of BLLs greater than or equal to 25 ug/dL increased by 11% over those reported for the same period in 1996 (Table_1). ** This increase contrasts with the long-term decreasing trend noted in ABLES data (2,3) and among adults in the United States (4). Annual Reports, 1996

Overall reports of BLLs greater than or equal to 25 ug/dL decreased from 28,943 in 1995 to 25,894 in 1996 (Table_2); this represented an 11% decrease for the same 25 states reporting in each year. *** The reported number of persons with BLLs greater than or equal to 25 ug/dL decreased by 4% from 13,231 in 1995 to 12,672 in 1996, while the number of new cases was stable (6189 new cases in each year) (Table_2); the only category for which an increase occurred from 1995 to 1996 was the number of new cases with BLLs greater than or equal to 50 ug/dL, the level designated by the Occupational Safety and Health Administration (OSHA) for medical removal from the workplace, which increased by 7% from 406 in 1995 to 434 in 1996. In comparison, from 1994 to 1995, the number of reports of BLLs greater than or equal to 25 ug/dL decreased by 1%, the number of persons with BLLs greater than or equal to 25 ug/dL increased by 8%, and the number of new cases decreased by 3%.

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, 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, Bur of Health, Maine Dept of Human Svcs. E Keyvan-Larijani, MD, Lead Poisoning Prevention Program, Maryland Dept of Health and Mental Hygiene. R Rabin, MSPH, Div of Occupational Hygiene, Massachusetts Dept of Public Health. 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 State Dept of Health and Senior Svcs. D Grogin, MS, New Mexico 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 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, K Ramaswamy, MSc, Bur of Epidemiology, 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. 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 Dept of Health. J Tierney, Div of Health, 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 data reported for 1996 suggest a continued decline in the overall number of detected cases of elevated BLLs among adults, which is consistent with the overall decline reported during 1993-1995 (3). Declines in the number of detected 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. Alternatively, this decline may reflect diminished compliance with OSHA requirements for blood lead monitoring and/or a reduction in the size of the workforce in lead-using industries. Variation in nationwide reporting totals also may result from 1) changes in the roster of participating states, 2) changes in staffing and funding in state-based surveillance programs, and 3) state-specific differences in worker BLL testing by lead-using industries. The increase in reports for the first quarter of 1997 is an exception to this trend of decreasing reports. However, this increase may represent variation in quarterly reporting rather than changes in adult lead exposures; continued surveillance is required before this first quarter increase can be adequately interpreted.

The findings in this report document the continuing hazard of lead exposures as an occupational health problem in the United States. The ABLES program seeks 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. The effort, described below, by the Bureau of Epidemiology of the Pennsylvania Department of Health (PDH) to improve the adult BLL reporting capability for Pennsylvania is an example of surveillance enhancement fostered by the ABLES program.

During 1994-1995, Pennsylvania provided numbers of BLL reports greater than or equal to 25 ug/dL, but did not report numbers of persons or new cases. Because Pennsylvania accounted for approximately 27% of all elevated BLLs reported, it was important to estimate the numbers of persons and new cases for Pennsylvania rather than omit this substantial portion of the data from the nationwide totals. Therefore, the estimated numbers of persons and new cases for Pennsylvania were based on the number of BLL reports from Pennsylvania and the proportions of persons and new cases to total BLL reports among the other ABLES states. These estimates, identified as such, were included in the yearly totals previously reported for the states in the ABLES program for 1994 and 1995 (1). With the assistance of the PDH's Bureau of Epidemiology, analysis of the database for Pennsylvania for 1994 and 1995 has determined the actual numbers of persons and new cases with BLLs greater than or equal to 25 ug/dL: for 1994, a total of 2005 persons (compared with 2938 estimated previously) and 1089 new cases (compared with 1328); for 1995, a total of 2897 persons (compared with 3481) and 1779 new cases (compared with 1562). **** The following corrections in the MMWR ABLES nationwide totals reported previously for 1994 (1) and 1995 (1) result from the addition of these updated Pennsylvania data: in 1994, the nationwide number of persons with BLLs greater than or equal to 25 ug/dL (reported as 12,137) should be 11,204, and the number of new cases (reported as 5619) should be 5380; in 1995, the total number of persons with BLLs greater than or equal to 25 ug/dL (reported as 12,664) should be 12,080, and the number of new cases (reported as 4993) should be 5210.

References

1. CDC. Adult blood lead epidemiology and surveillance -- United States, first quarter 1996, and annual 1995. MMWR 1996;45:628-31.

2. CDC. Adult blood lead epidemiology and surveillance -- United States, fourth quarter, 1996. MMWR 1997;46:358-60,367.

3. CDC. Adult blood lead epidemiology and surveillance -- United States, third quarter, 1996. MMWR 1997;46:105-7.

4. CDC. Update: blood lead levels -- United States, 1991-1994. MMWR 1997;46:141-6.

* 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. 

** To compare estimates for first quarter data for 1997 and 1996 for a constant roster of 28 states, first quarter 1997 data for New Mexico, Rhode Island, and Wyoming were added to the previously reported totals for the first quarter of 1996 (1), and estimates for first quarter 1996 data for Illinois, which discontinued reporting at the end of 1996, were included in the first quarter totals for 1997. 

*** To compare data for the same 25 states in both years, 1996 annual data for Minnesota and Ohio were added to previously published data for 23 states in 1995 (1). The 1995 data have been updated with corrected Pennsylvania data for reported persons and new cases. 

**** The number of new cases for 1996 in this report (Table_2) still contains an estimate for Pennsylvania. Because of a change in computer databases, actual data for Pennsylvania will be provided for 1996 and for future years.

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 -- 28 states,* first quarter, 1997
===========================================================================================================================================
                                  First quarter 1997                                                            % Change from first quarter
Reported BLL (ug/dL)         No. reports +   No. persons &            No. reports first quarter 1996 @              quarter 1996 to 1997
-------------------------------------------------------------------------------------------------------------------------------------------
25-39                                5772           3998                              5027                                     15%
40-49                                1110            752                              1177                                    - 6%
50-59                                 232            165                               214                                      8%
 >=60                                 113             74                               104                                      9%
Total                                7227           4989                              6522                                     11%
-------------------------------------------------------------------------------------------------------------------------------------------
* Reported by 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. First quarter 1996 data for Illinois, which no longer reports, are included as an estimate for first
  quarter 1997 to allow comparison of data for a constant roster of 28 states.
+ First quarter 1996 data were used as an estimate for Ohio because of problems in Ohio�s 1997 first quarter report.
& Individual reports for persons are categorized according to the highest reported BLL for the person during the given quarter. The number
  of persons reported in Michigan is an estimate based on the number of reports received. First quarter 1996 data were used as an estimate
  for Ohio because of problems in Ohio�s 1997 first quarter report.
@ First quarter 1997 data for New Mexico, Rhode Island, and Wyoming are included in addition to previously published 1996 totals ( 1 ) to
  compare data for the same 28 states.
===========================================================================================================================================

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 -- 25 states,+ 1995 and 1996
==============================================================================================================================================
                                                      1996                                                 1995
                             -----------------------------------------------------   ---------------------------------------------------------
                                                                     New cases                                            New cases
                                                                  --------------                                       --------------
Highest BLL (ug/dL)          No. reports &      No. persons @      No.      (%)      No reports &     No. persons @     No.      (%)
----------------------------------------------------------------------------------------------------------------------------------------------
25-39                             20,335             9,884        4,900     (50)        21,754            9,888        4,705     (48)
40-49                              4,228             2,037          855     (42)         5,629            2,560        1,078     (42)
50-59                                847               492          244     (50)         1,061              527          235     (45)
 >=60                                484               259          190     (73)           499              256          171     (67)
Total                             25,894            12,672        6,189     (49)        28,943           13,231        6,189     (47)
----------------------------------------------------------------------------------------------------------------------------------------------
* A new case is defined as at least one report of a BLL >=25 ug/dL in an adult appearing in state surveillance data during the current year
  who was not recorded in the immediately preceding year. In 1995, new cases were not reported for Illinois, Michigan, and South Carolina;
  data for those states were estimated based on proportions from the other states and the number of reports, persons, or unassigned new cases.
  Also in 1995, new cases for Alabama, New Hamp-shire, and Vermont were missing; 1994 data were used as an estimate. In 1996, new cases were
  not reported for Illinois, Michigan, New Hampshire, Pennsylvania, South Carolina, and Vermont; new cases for those states were estimated
  based on proportions from the other states and the number of reports, persons, or unassigned new cases.
+ Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey,
  New York, North Carolina, Ohio, Okla-homa, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont,Washington, and Wisconsin. To compare
  data for the same 25 states, Minnesota and Ohio data for 1996 were added to previously published 1995 data for 23 states ( 1 ). The 1995
  data also have been updated with actual Pennsylvania data for reported persons and new cases, which replace the estimates previously used.
& In 1995, data for Alabama and Vermont were missing; 1994 data were used as estimates. In 1996, fourth quarter data for Illinois were
  missing; 1995 fourth quarter data were used as an estimate.
@ Individual reports are categorized according to the highest reported BLL for the person during the given year. In 1995, data for Alabama
  and Vermont were missing; 1994 data were used as an estimate. In 1995 and 1996, the number of persons was not reported by Michigan; the
  number of persons was estimated based on the proportions from the other states and the number of reports from Michigan. In 1996, fourth
  quarter data for Illinois were missing; 1995 fourth quarter data were used as an estimate.
==============================================================================================================================================

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