title: The impact of low-level lead toxicity on school performance among children in the Chicago Public Schools: a population-based retrospective cohort study.
abstract: BACKGROUND
  Environmental lead exposure poses a risk to educational performance, especially among poor, urban children. Previous studies found low-level lead exposure was a risk factor for diminished academic abilities, however, this study is distinct because of the very large sample size and because it controlled for very low birth weight and early preterm birth-two factors closely associated with lower academic performance. In this study we examined the association between lead concentration in whole blood (B-Pb) of Chicago Public School (CPS) children and their performance on the 3(rd) grade Illinois Standard Achievement Tests (ISAT) reading and math scores.
  
  
  METHODS
  We examined 58,650 children born in Chicago between 1994 and 1998 who were tested for blood lead concentration between birth and 2006 and enrolled in the 3(rd) grade at a CPS school between 2003 and 2006. We linked the Chicago birth registry, the Chicago Blood Lead Registry, and 3(rd) grade ISAT scores to examine associations between B-Pb and school performance.
  
  
  RESULTS
  After adjusting for other predictors of school performance including poverty, race/ethnicity, gender, maternal education and very low birth weight or preterm-birth, we found that B-Pbs below 10 μg/dL were inversely associated with reading and math scores in 3(rd) grade children. For a 5 μg/dL increase in B-Pb, the risk of failing increased by 32% for reading (RR = 1.32, 95%CI = 1.26, 1.39) and math (RR = 1.32, 95%CI = 1.26, 1.39). The effect of lead on reading was non-linear with steeper failure rates at lower B-Pbs. We estimated that 13% of reading failure and 14.8% of math failure can be attributed to exposure to blood lead concentrations of 5 to 9 vs. 0 to 4 μg/dL in Chicago school children.
  
  
  CONCLUSIONS
  Early childhood lead exposure is associated with poorer achievement on standardized reading and math tests in the third grade, even at very low B-Pbs. Preventing lead exposure in early childhood is critical to improving school performance.
authors.affiliation: University of Illinois at Chicago, 2121 W. Taylor Street, Chicago, 60612, IL, USA. anne.evens@elevateenergy.org.
authors.forename: Anne
authors.initials: A
authors.lastname: Evens
authors.affiliation: University of Illinois at Chicago, 2121 W. Taylor Street, Chicago, 60612, IL, USA. dhryhorc@uic.edu.|University of Illinois at Chicago, Center for Global Health, College of Medicine, 1940 W. Taylor Street, Chicago, 60612, IL, USA. dhryhorc@uic.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hryhorczuk
authors.affiliation: Child & Family Research Institute, BC Children's Hospital and Faculty of Health Sciences, Simon Fraser University, Vancouver, V5Z 3E5, BC, Canada. blanphear@sfu.ca.
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Lanphear
authors.affiliation: University of Illinois at Chicago, 2121 W. Taylor Street, Chicago, 60612, IL, USA. krankin@uic.edu.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Rankin
authors.affiliation: Northwestern University, School of Education and Social Policy, 2120 Campus Drive, Evanston, 60208, IL, USA. dlewis@northwestern.edu.
authors.forename: Dan A
authors.initials: DA
authors.lastname: Lewis
authors.affiliation: University of Illinois at Chicago, 2121 W. Taylor Street, Chicago, 60612, IL, USA. forst-l@uic.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Forst
authors.affiliation: University of Illinois at Chicago, 2121 W. Taylor Street, Chicago, 60612, IL, USA. drose@uic.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Rosenberg
mesh_terms: D000124:Achievement; D002641:Chicago; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004781:Environmental Exposure; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007854:Lead / Q000097:blood*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012574:Schools
chemical_list: D007854:Lead