title: Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response.
abstract: OBJECTIVE
  We analyzed differences in pediatric elevated blood lead level incidence before and after Flint, Michigan, introduced a more corrosive water source into an aging water system without adequate corrosion control.
  
  
  METHODS
  We reviewed blood lead levels for children younger than 5 years before (2013) and after (2015) water source change in Greater Flint, Michigan. We assessed the percentage of elevated blood lead levels in both time periods, and identified geographical locations through spatial analysis.
  
  
  RESULTS
  Incidence of elevated blood lead levels increased from 2.4% to 4.9% (P < .05) after water source change, and neighborhoods with the highest water lead levels experienced a 6.6% increase. No significant change was seen outside the city. Geospatial analysis identified disadvantaged neighborhoods as having the greatest elevated blood lead level increases and informed response prioritization during the now-declared public health emergency.
  
  
  CONCLUSIONS
  The percentage of children with elevated blood lead levels increased after water source change, particularly in socioeconomically disadvantaged neighborhoods. Water is a growing source of childhood lead exposure because of aging infrastructure.
authors.affiliation: Mona Hanna-Attisha and Allison Champney Schnepp are with Hurley Children's Hospital/Michigan State University College of Human Medicine, Department of Pediatrics and Human Development, Flint, MI. Jenny LaChance is with Hurley Medical Center Research, Flint. Richard Casey Sadler is with Michigan State University College of Human Medicine, Division of Public Health, Flint.
authors.forename: Mona
authors.initials: M
authors.lastname: Hanna-Attisha
authors.affiliation: Mona Hanna-Attisha and Allison Champney Schnepp are with Hurley Children's Hospital/Michigan State University College of Human Medicine, Department of Pediatrics and Human Development, Flint, MI. Jenny LaChance is with Hurley Medical Center Research, Flint. Richard Casey Sadler is with Michigan State University College of Human Medicine, Division of Public Health, Flint.
authors.forename: Jenny
authors.initials: J
authors.lastname: LaChance
authors.affiliation: Mona Hanna-Attisha and Allison Champney Schnepp are with Hurley Children's Hospital/Michigan State University College of Human Medicine, Department of Pediatrics and Human Development, Flint, MI. Jenny LaChance is with Hurley Medical Center Research, Flint. Richard Casey Sadler is with Michigan State University College of Human Medicine, Division of Public Health, Flint.
authors.forename: Richard Casey
authors.initials: RC
authors.lastname: Sadler
authors.affiliation: Mona Hanna-Attisha and Allison Champney Schnepp are with Hurley Children's Hospital/Michigan State University College of Human Medicine, Department of Pediatrics and Human Development, Flint, MI. Jenny LaChance is with Hurley Medical Center Research, Flint. Richard Casey Sadler is with Michigan State University College of Human Medicine, Division of Public Health, Flint.
authors.forename: Allison
authors.initials: A
authors.lastname: Champney Schnepp
mesh_terms: D002675:Child, Preschool; D060766:Drinking Water / Q000009:adverse effects*; D004781:Environmental Exposure / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D007854:Lead / Q000097:blood* / Q000633:toxicity; D007855:Lead Poisoning / Q000453:epidemiology*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011634:Public Health; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000097:blood
chemical_list: D060766:Drinking Water; D014874:Water Pollutants, Chemical; D007854:Lead