Adult Blood Lead Epidemiology and Surveillance -- United States, 1992-1994

CDC's National Institute for Occupational Safety and Health Adult Blood Lead Epidemiology and Surveillance program (ABLES) monitors elevated blood lead levels (BLLs) among adults in the United States (1). Twenty-two states currently report surveillance results to ABLES. Beginning in 1993, ABLES began detecting both new cases and persons with multiple reports over time. In this report, ABLES provides data for the first quarter of 1994 and compares annual data for 1993 and 1992.

During January 1-March 31, 1994, the number of reports of elevated BLLs increased over those reported for the same period in both 1992 and 1993 in all reporting categories (Table_1); this increase is consistent with the increase from 1992 to 1993 in total annual BLL reports (2). The number of reports of adults with elevated BLLs reflects monitoring practices by employers. Variation in national quarterly reporting totals, especially first-quarter totals, may result from 1) changes in the number of participating states; 2) timing of receipt of laboratory BLL reports by state-based surveillance programs; and 3) interstate differences in worker BLL testing by lead-using industries.

The reported number of adults with elevated BLLs increased from 8886 in 1992 to 11,240 in 1993 (Table_2); this increase resulted in part from a net gain of two reporting states (three additions and one deletion) to ABLES in 1993. A total of 6584 new case reports * accounted for 59% of the total cases (11,240) reported during 1993.

Fifty-two percent of persons reported in 1992 were reported again to the system during 1993. Reasons for repeat reports of elevated BLLs include 1) recurring exposure resulting from lack of existing control measures and inapropriate worker-protection practices; 2) routine tracking of elevated employee BLLs below the medical removal limits; and 3) increased employer monitoring during medical removal. Increased testing of workers in construction trades -- as new workplace medical-monitoring programs are established to comply with new Occupational Safety and Health Administration regulations (3) -- also may partially explain increases in reports of elevated BLLs.

These data suggest that work-related lead exposure is an ongoing occupational health problem in the United States. By expanding the number of participating states, reducing variability in reporting, and distinguishing between new and recurring elevated BLLs in adults, ABLES can enhance surveillance for this preventable condition.

Reported by: NH Chowdhury, MBBS, Alabama Dept of Public Health. C Fowler, MS, Arizona Dept of Health Svcs. FJ Mycroft, PhD, Occupational Health Br, California Dept of Health Svcs. BC Jung, MPH, Connecticut Dept of Public Health and Addiction Svcs. M Lehnherr, Occupational Disease Registry, Div of Epidemiologic Studies, Illinois Dept of Public Health. R Gergely, Iowa Dept of Public 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. A Carr, MBA, Bur of Child and Family Svcs, Michigan Dept of Public Health. D Solet, PhD, 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. E Rhoades, MD, Oklahoma State Dept of Health. M Barnett, 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. D Perrotta, PhD, Bur of Epidemiology, Texas Dept of Health. D Beaudoin, MD, 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. D Higgins, Wisconsin Dept of Health and Social Svcs. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

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, fourth quarter, 1993. MMWR 1994;43:246-7.

3. Office of the Federal Register. Code of federal regulations: occupational safety and health standards. Subpart Z: toxic and hazardous substances -- lead. Washington DC: Office of the Federal Register, National Archives and Records Administration, 1993. (29 CFR section 1926, part II).

* At least one report of an adult with an elevated BLL ( greater than or equal to 25 ug/dL) who had not been reported previously in 1992. Of the newly reported cases in 1993, 257 (4%) were reported by new ABLES states (for which all cases are considered new).

TABLE 1. Reports of elevated blood lead levels (BLLs) among adults -- 22 states, *
first quarter, 1992-1994
==============================================================================================================
                     First quarter, 1994         Reports,         Reports,
Reported BLL     ---------------------------   first quarter    first quarter
  (ug/dL)        No. reports   No. persons +      1993 &           1992 @
-----------------------------------------------------------------------------
25-39               4086          3295             3360             3475
40-49               1370          1014              846              904
50-59                275           202              162              221
 >=60                116            86               79               86

Total               5847          4597             4447             4686
-----------------------------------------------------------------------------
* Reported by Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maryland, Massachusetts, Michigan,
  New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina,
  Texas, Utah, Vermont, Washington, and Wisconsin.
+ Individual reports are categorized according to the highest reported BLL for the individual during the
  given quarter.
& Data for first quarter 1993 were reported from 17 states (Alabama, Connecticut, Illinois, Iowa, Maryland,
  Massachusetts, Michigan, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Texas,
  Utah, Vermont, and Wisconsin). Data on number of persons with elevated BLLs are unavailable.
@ Data for first quarter 1992 were reported from 12 states (Alabama, California, Connecticut, Illinois,
  Iowa, Maryland, Massachusetts, New Jersey, New York, Oregon, Texas, and Wisconsin). Data on number of
  persons with elevated BLLs are unavailable.
==============================================================================================================

TABLE 2. Reports of new cases of elevated blood lead levels (BLLs) among adults --
20 states *, 1993
====================================================================================================================
                                                          New cases &
Highest BLL                                            ----------------
  (ug/dL)       No. reports *      No. persons +        No.         (%)
-----------------------------------------------------------------------
  25-39            17,045              8,041           4,693       (58)
  40-49             5,189              2,293           1,288       (56)
  50-59             1,208                627             419       (67)
   >=60               583                279             184       (66)


  Total            24,025             11,240           6,584       (59)
-----------------------------------------------------------------------
* Reported by Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maryland, Massachusetts, Michigan, New
  Hampshire, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont, Washington, and
  Wisconsin.
+ Individual reports are categorized according to the highest reported BLL for the individual during the given
  year.
& Reported by Alabama, California, Colorado, Connecticut, Illinois, Iowa, Maryland, Massachusetts, New Jersey, New
  York, Oregon, Pennsylvania, South Carolina, Texas, Utah, and Wisconsin.
====================================================================================================================

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