P3.E092: Socio-economic disparities in lead poisoning hospitalization in the United States

Background: The toxic effects of lead have been recognized for a long time with no level of lead in blood being considered safe. Here, we present nationwide data on hospitalized children with lead poisoning and hypothesize that children from poor neighborhoods have an increased risk of lead poisoning compared to those from more affluent neighborhoods.

Methods: We performed a serial cross-sectional analysis of nationally representative samples of lead poisoning admissions for the years 2003, 2006, 2009, 2012 and 2016 from Kids’ Inpatient Database (KID). We used 984.x and T56.0xx for ICD9 and ICD10, respectively, to identify children with lead poisoning. Once identified, we analyzed the data to study the differences in the rate of hospitalization between children of different socio-economic groups and other secondary outcomes according to age, hospital region and race.

Results: Out of 35,268,636 pediatric hospitalizations, 1,702 children were admitted with a diagnosis of lead poisoning. The number of lead poisoning cases decreased from 2003 to 2016, with 7.0 per 100,000 admissions in 2003 to 4.2 per 100,000 admissions in 2016 (p=0.008). The rate of admission was highest in children less than 5 years of age, comprising 1,387 (81.5%) cases. The Northeast geographical region had the highest rate of hospitalization, with 13.5/100,000 admissions, while the West had the lowest rate of 1.0/100,000 admissions (p < 0.001). Compared to White children, Black and Hispanic children had increased rates of lead poisoning by 6- and 2-fold, respectively (Table). Children living in the poorest neighborhoods had the highest rate of hospitalization of 8.7/100,000 admissions, compared to 1.8/100,000 admissions among those who live in the richest neighborhoods. In a logistic regression modeling, children in the poorest neighborhoods had an increased odds ratio of hospital admission due to lead poisoning of 4.9 (95% CI: 3.6 - 6.6, p < 0.001). After adjusting for confounders, the odds ratio was still significant at 3.6 (95% CI: 2.7 - 4.9, p < 0.001) (Figure).

Conclusion: The children living in poorer neighborhoods are at higher risk of lead poisoning compared to those living in wealthier neighborhoods. The reason for this disparity is likely multifactorial with a significant impact. There is a need for better public health education and appropriate interventions to improve this disparity.