title: Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999.
abstract: BACKGROUND
  Few studies have examined factors related to the time required for children's blood lead levels (BLLs) > or = 10 microg/dL to decline to < 10 microg/dL.
  
  
  OBJECTIVE
  We used routinely collected surveillance data to determine the length of time and risk factors associated with reducing elevated BLLs in children below the level of concern of 10 microg/dL.
  
  
  METHODS
  From the North Carolina and Vermont state surveillance databases, we identified a retrospective cohort of 996 children < 6 years of age whose first two blood lead tests produced levels > or = 10 microg/dL during 1996-1999. Data were stratified into five categories of qualifying BLLs and analyzed using Cox regression. Survival curves were used to describe the time until BLLs declined below the level of concern. We compared three different analytic methods to account for children lost to follow-up.
  
  
  RESULTS
  On average, it required slightly more than 1 year (382 days) for a child's BLL to decline to < 10 microg/dL, with the highest BLLs taking even longer. The BLLs of black children [hazard ratio (HR) = 0.84; 95% confidence interval (CI), 0.71-0.99], males (HR(male) = 0.83; 95% CI, 0.71-0.98), and children from rural areas (HR(rural) = 0.83; 95% CI, 0.70-0.97) took longer to fall below 10 microg/dL than those of other children, after controlling for qualifying BLL and other covariates. Sensitivity analysis demonstrated that including censored children estimated a longer time for BLL reduction than when using linear interpolation or when excluding censored children.
  
  
  CONCLUSIONS
  Children with high confirmatory BLLs, black children, males, and children from rural areas may need additional attention during case management to expedite their BLL reduction time to < 10 microg/dL. Analytic methods that do not account for loss to follow-up may underestimate the time it takes for BLLs to fall below the recommended target level.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Lead Poisoning Prevention Branch, Atlanta, GA 30341, USA. tdignam@cdc.gov
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Dignam
authors.forename: Jose
authors.initials: J
authors.lastname: Lojo
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Meyer
authors.forename: Ed
authors.initials: E
authors.lastname: Norman
authors.forename: Amy
authors.initials: A
authors.lastname: Sayre
authors.forename: W Dana
authors.initials: WD
authors.lastname: Flanders
mesh_terms: D015913:Chelation Therapy; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007855:Lead Poisoning / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D044469:Racial Groups; D012111:Residence Characteristics; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014707:Vermont / Q000453:epidemiology