Adult Blood Lead Epidemiology and Surveillance -- United States, Fourth Quarter, 1996

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 25 states.* This report presents ABLES data through the fourth quarter of 1996, compares these data with that from the same period in 1995, and describes cases of severe lead poisoning in adults in New York during 1996.

During October 1-December 31, 1996, the 6215 reports of BLLs greater than or equal to 25 ug/dL represented an 11% decrease from the 7014 reported for the fourth quarter of 1995 (1), which now include previously unpublished data for Minnesota and Ohio. For the four quarters of 1996, the number of reports of BLLs greater than or equal to 25 ug/dL decreased by 8%, compared with the number reported for the four quarters of 1995 (2), which also now include previously unpublished data for Minnesota and an estimate for Ohio (Table_1). The cumulative number of reports in 1996 decreased at each reporting blood lead level, compared with data for 1995. This overall trend of decreasing reports is consistent with the third quarter report for 1996 (3).

Since 1981, the New York State Department of Health has maintained a registry of poisonings associated with lead and other heavy metals. During 1982-1993, the number of cases of severe lead poisoning (defined as reported BLLs greater than 100 ug/dL) ranged from one to 12 adults per year. Of the 64 cases reported during that period, 42 (66%) were occupationally related; of these, a total of 22 (52%) occurred among manufacturing workers and 18 (43%) among construction workers. Structural steel workers accounted for most of the construction workers exposed to lead during the refurbishing or demolition of bridges.

In 1994, one case of nonoccupational severe lead poisoning was reported, and in 1995 no such cases were reported. However, during 1996, seven cases of severe lead poisoning were reported. Four (57%) were occupationally related, and all occurred among residential painters; the highest BLL for the most severe case was 256 ug/dL (the highest occupational BLL reported in New York since 1983). The follow-up investigation of this reported case suggested that the primary exposure occurred while the worker used a mechanical sander to remove paint from the exterior of a house. He did not wear a respirator during this activity and frequently smoked cigarettes while working, which probably pyrolized lead in the paint dust and increased his exposure.

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, Connecticut Dept of Public Health. M Lehnherr, Occupational Disease Registry, Div of Epidemiologic Studies, Illinois Dept of Public Health. R Gergely, Iowa Dept of Public Health. A Hawkes, MD, Occupational Health Program, Maine Bur of Health. E Keyvan-Larijani, MD, Lead Poisoning Prevention Program, Maryland Dept of the Environment. R Rabin, MSPH, Div of Occupational Hygiene, Massachusetts Dept of Labor and Industries. M Scoblic, MN, Michigan Dept of Public Health. M Falken, PhD, Minnesota Dept of Health. L Thistle-Elliott, MEd, Div of Public Health Svcs, New Hampshire State Dept of Health and Human Svcs. B Gerwel, MD, Occupational Disease Prevention Project, New Jersey Dept of Health and Senior Svcs. M London, MS, 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. A Gardner-Hillian, Div of Health Hazard Evaluations, South Carolina Dept of Health and Environmental Control. P Schnitzer, PhD, 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. J Kaufman, MD, Washington State Dept of Labor and Industries. J Tierney, Wisconsin Dept of Health and Social Svcs. Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: The findings in this report for the fourth quarter of 1996 suggest a continued decline in the overall number of detected cases of elevated BLLs among adults, which is consistent with the overall decline reported during 1993-1995 (3). This decline may reflect decreased occupational exposures to lead, diminished compliance with Occupational Safety and Health Administration requirements regarding blood lead monitoring, and/or a reduction in the size of the workforce in lead-using industries. Variation in nationwide reporting totals also may result from

1. changes in the roster of participating states, 2) changes in staffing and funding in state-based surveillance programs, and 3) interstate differences in worker BLL testing by lead-using industries.

In recent years, increased control efforts have been directed toward the hazards of lead -- particularly to the risks for children who may be exposed to lead-based painted surfaces in their homes, schools, and day-care settings. These efforts have included attempts to remove lead-based paint in many older buildings (built before 1978). The cases of severe lead poisoning reported from New York illustrate the risks to workers and to building occupants as the result of improper methods for paint removal. Health departments and medical practitioners in areas where there are substantial numbers of structures built before 1978 should be alert to these risks.

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, reducing variability in reporting, distinguishing between new and recurring elevated BLLs in adults and, as in the cases reported from New York, by facilitating the identification of possible new exposures.

References

1. CDC. Adult blood lead epidemiology and surveillance -- United States, fourth quarter, 1995. MMWR 1996;45:333-4.

2. CDC. Adult blood lead epidemiology and surveillance -- United States, first quarter 1996, and annual 1995. MMWR 1996;45:628-31.

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

* Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont, Washington, and Wisconsin.
Table_1
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TABLE 1. Number of reports of elevated blood lead levels (BLLs) among adults, number
of persons with elevated BLLs, and percentage change in number of reports --
25 states,* fourth quarter, 1996
====================================================================================================
                    Fourth quarter, 1996       Cumulative     Cumulative
Reported BLL    -----------------------------    reports,       reports      % Change from
(ug/dL)         No. reports +   No. persons &     1995 @        1996 **      1995 to 1996
------------------------------------------------------------------------------------------
25-39               4,894           3,507         21,813         20,715          - 5%
40-49                 983             675          5,609          4,597          -18%
50-59                 183             125          1,059            890          -16%
 >=60                 155              96            499            490          - 2%

Total               6,215           4,403         28,980         26,692          - 8%
------------------------------------------------------------------------------------------
 * Alabama, Arizona, California, Connecticut, Illinois, Iowa, Maine, Maryland, Massachusetts,
   Michigan, Minnesota, New Hampshire, New Jersey, New York, North Carolina, Ohio,
   Oklahoma, Oregon, Pennsylvania, South Carolina, Texas, Utah, Vermont, Washington, and
   Wisconsin.
 + Data for Alabama and Illinois were missing; fourth quarter 1995 data were used as an
   estimate for Illinois and first quarter 1995 data (the most recent reports available) were used
   for Alabama.
 & Individual reports for persons are categorized according to the highest reported BLL for the
   person during the given quarter. Data for Alabama and Illinois were missing; fourth quarter
   1995 data were used as an estimate for Illinois and first quarter 1995 data (the most recent
   reports available) were used for Alabama.
 @ Data for Minnesota and Ohio are included for the first time in addition to previously
   published 1995 totals (2). For Minnesota, first through fourth quarter data for 1995 were
   used; for Ohio, first through fourth quarter data for 1996 were used as an estimate.
** The cumulative number of reports for all four quarters includes year-end adjustments and
   corrections made by the states and may not be derived by simply adding the number of
   reports in each of the four quarters.
====================================================================================================

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