title: Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France.
abstract: The decline in children's Blood Lead Levels (BLL) raises questions about the ability of current lead poisoning screening criteria to identify those children most exposed. The objectives of the study were to evaluate the performance of current screening criteria in identifying children with blood lead levels higher than 50 µg/L in France, and to propose new criteria. Data from a national French survey, conducted among 3831 children aged 6 months to 6 years in 2008-2009 were used. The sensitivity and specificity of the current criteria in predicting blood lead levels higher than or equal to 50 µg/L were evaluated. Two predictive models of BLL above 44 µg/L (for lack of sufficient sample size at 50 µg/L) were built: the first using current criteria, and the second using newly identified risk factors. For each model, performance was studied by calculating the area under the ROC (Receiver Operating Characteristic) curve. The sensitivity of current criteria for detecting BLL higher than or equal to 50 µg/L was 0.51 (0.26; 0.75) and specificity was 0.66 (0.62; 0.70). The new model included the following criteria: foreign child newly arrived in France, mother born abroad, consumption of tap water in the presence of lead pipes, pre-1949 housing, period of construction of housing unknown, presence of peeling paint, parental smoking at home, occupancy rates for housing and child's address in a cadastral municipality or census block comprising more than 6% of housing that is potentially unfit and built pre-1949. The area under the ROC curve was 0.86 for the new model, versus 0.76 for the current one. The lead poisoning screening criteria should be updated. The risk of industrial, occupational and hobby-related exposure could not be assessed in this study, but should be kept as screening criteria.
authors.affiliation: INSERM (National Institute of Health and Medical Research) U1085, Irset-Environmental and Occupational Health Research Institute, Rennes 35043, France. anne.etchevers@gmail.com.
authors.forename: Anne
authors.initials: A
authors.lastname: Etchevers
authors.affiliation: INSERM (National Institute of Health and Medical Research) U1085, Irset-Environmental and Occupational Health Research Institute, Rennes 35043, France. philippe.glorennec@ehesp.fr.|EHESP (School of Public Health), Sorbonne Paris Cité, Rennes 35043, France. philippe.glorennec@ehesp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Glorennec
authors.affiliation: InVS-French Institute for Public Health Surveillance, Saint Maurice 94415, France. y.lestrat@invs.sante.fr.
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Strat
authors.affiliation: InVS-French Institute for Public Health Surveillance, Saint Maurice 94415, France. c.lecoffre@invs.sante.fr.
authors.forename: Camille
authors.initials: C
authors.lastname: Lecoffre
authors.affiliation: Ministry of Health, Directorate for Health, Paris 75350, France. Philippe.BRETIN@sante.gouv.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bretin
authors.affiliation: InVS-French Institute for Public Health Surveillance, Saint Maurice 94415, France. a.letertre@invs.sante.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Le Tertre
mesh_terms: D002648:Child; D002675:Child, Preschool; D004784:Environmental Monitoring / Q000592:standards*; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007854:Lead / Q000097:blood*; D020264:Lead Poisoning, Nervous System, Childhood / Q000097:blood*; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008962:Models, Theoretical; D010150:Paint / Q000009:adverse effects*; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D007854:Lead
keywords: child; exposure; health; lead poisoning; screening evaluation