Elevated Blood Lead Levels Among Refugee Children in Urban Primary Care: A Retrospective Analysis Following Revised CDC Guidelines.

Abstract

Refugee children are at increased risk for lead exposure due to environmental hazards encountered before, during, and after resettlement. In 2021, the Centers for Disease Control and Prevention (CDC) lowered the blood lead reference value (BLRV) from 5.0 to 3.5 micrograms per deciliter (µg/dL), prompting the need to reassess screening guidelines, practices, and follow-up care. This retrospective chart review evaluated blood lead levels (BLLs) among refugee and non-refugee children aged 1 to 6 years old who received care at an urban primary care center in Hartford, Connecticut (CT) from 2020 to 2023. Of 565 patients, 24 were identified as refugees. Refugee children had 1.94 times the risk of BLLs ≥ 3.5 µg/dL (p = 0.034) and 4.36 times the risk of BLLs ≥ 5.0 µg/dL (p = 0.0002) compared to non-refugees, while causing only a slight increase in prevalence. Refugees represented 4.2% of the total sample but 16.2% of children with BLLs ≥ 5.0 µg/dL. Notably, while refugees in this cohort originated from multiple countries, 83% of those with BLLs ≥ 5.0 µg/dL were born in or last resided in Afghanistan, suggesting that although there appears to be an association between this country and lead exposure, lead exposure risk may have occurred anywhere along the migration path, including the country of birth, the country of nationality, and intermediary countries where families lived prior to United States (U.S.) resettlement. These findings highlight the need to follow the CDC Refugee Health Guidelines for post-resettlement lead screening, and to work towards improved coordination between primary care providers and resettlement agencies. Although many refugee children may have experienced initial exposures overseas, public health efforts should not assume this eliminates new or ongoing exposure, as the family may have brought lead containing pottery or cosmetics with them, or are being resettled into an older home that may contain lead. So, there should be a focus on preventing further exposure, identifying sources of lead, and ensuring timely follow-up of elevated BLL. Broader policy and community engagement are essential to reduce disparities in lead exposure and the burden of elevated blood lead levels among refugee children.