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Adult Blood Lead Epidemiology and Surveillance -- United States, Fourth Quarter, 1997

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. During 1997, a total of 27 states reported surveillance data to ABLES. * This report presents ABLES data through the fourth quarter for 1997 and compares the data for each quarter of 1997 with data reported for the corresponding quarter of 1996; preliminary totals for the fourth quarter 1997 reports suggest that the overall number of persons with BLLs greater than or equal to 25 ug/dL were similar for 1996 and 1997.

Beginning with this report, the focus is on the number of persons with elevated BLLs (prevalence); previous ABLES reports focused primarily on the number of laboratory reports of elevated BLLs (there are often multiple laboratory reports for the same person, representing repeat or follow-up testing of the person). The number of new cases of elevated BLLs (incidence) will continue to be reported as cumulative annual data, which accompanies the succeeding year's first quarter report.

States in the ABLES program mandate that laboratories report elevated BLLs for adults to the state health departments or another designee. The minimum BLL required to be reported varies among the states; the ABLES definition of an elevated BLL is greater than or equal to 25 ug/dL. ABLES follow-back procedures have been previously described (1).

During October-December 1996 and 1997, the number of persons with BLLs greater than or equal to 25 ug/dL reported by the same 27 participating states decreased 5%, from 4229 (2) to 4010. ** This quarterly decrease in the number of persons with BLLs greater than or equal to 25 ug/dL follows no change from 1996 when compared with 1997 in the third quarter (from 3747 to 3748), a decrease of 6% in second quarter (from 4421 to 4148), and a 10% increase in first quarter (from 4198 to 4598) (Figure_1). A similar quarterly pattern was observed for the number of persons 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 {3}) -- decreases of 6% in the fourth quarter (from 250 to 236), 12% in the third quarter (from 214 to 188), and 20% in the second quarter (from 245 to 197), and an increase of 14% in the first quarter (from 194 to 222).

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, Div of Environmental Epidemiology and Occupational Health, Connecticut Dept of Public Health. R Gergely, Iowa Dept of Public Health. W Davis, MPA, 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 Safety, Massachusetts Dept of Labor and Industries. A Allemier, Dept of Medicine, Michigan State Univ, East Lansing. M Falken, PhD, Minnesota Dept of Health. C DeLaurier, 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. R Prophet, PhD, 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 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. M Stoeckel, MPH, Rhode Island and Providence Plantations Dept of Health. A Gardner-Hillian, Div of Health Hazard Evaluations, South Carolina Dept of Health and Environmental Control. D Salzman, MPH, 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. P Rajaraman, MS, Washington State Dept of Labor and Industries. J Tierney, 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: Beginning with this report, the ABLES program will report the prevalence of persons with elevated BLLs, rather than the number of laboratory reports of elevated BLLs. Prevalence is a more accurate measure of the burden of elevated BLLs among adults. ABLES continues to collect and analyze data about the number of laboratory reports for use in following persons with persistently high BLLs and for use as a measure of compliance with OSHA testing requirements. ***

The number of persons with elevated BLLs is not directly comparable with previously reported numbers of laboratory reports. However, trends in these two forms of data are similar, and the general pattern in the number of persons with elevated BLLs over the four quarters of 1997 suggests a continuation of the long-term declines observed for laboratory reports since 1993 (2,4,5). This decline detected in the last three quarters of 1997, when compared to the same period of 1996, may reflect decreased occupational exposures to lead through improved controls implemented by employers. Alternatively, the decreases might also reflect 1) decreased efforts of the various participating states, and lead-using industries within them, to identify lead-exposed workers; 2) a reduction in the size of the workforce in lead-using industries; and/or 3) a change in reporting laws or in compliance with these laws. Quarterly increases and decreases also might represent normal fluctuations in case reporting, which may result from changes in staffing and funding in state-based surveillance programs, interstate differences in worker BLL testing by lead-using industries, or random variation.

The findings in this report document the continuing hazard of lead exposures as an occupational health problem in the United States. ABLES enhances surveillance for this preventable condition by expanding the number of participating states, exploring ways to increase the usefulness of reporting, and alerting the public to potential new sources of lead exposure.


  1. CDC. Surveillance for occupational lead exposure -- United States, 1987. MMWR 1989;38:642-6.

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

  3. US Department of Labor, Occupational Safety and Health Administration. Final standard for occupational exposure to lead. Federal Register 1978;43:52952-3014. (29 CFR 1910.1025).

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

  5. CDC. Adult blood lead epidemiology and surveillance -- United States, first quarter, 1997, and annual 1996. MMWR 1997;46:643-7.

* 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. 

** To compare the number of persons for a constant roster of 27 states in 1997 and 1996, data for 1997 for New Mexico, Rhode Island, and Wyoming were added to previously reported totals for 1996 (1). In addition, 1996 data for Illinois, which no longer reports, were subtracted from previously reported totals for 1996 (1). Alabama and Ohio have updated their reports for 1996, and these updated data are now incorporated. 

*** The number of laboratory reports for the fourth quarter of 1997 was 5421, compared with 5874 in 1996.


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