In Rhode Island’s Lingering Lead Problem, MuckRock recently reported on the State of Rhode Island’s one-time plan to eliminate blood lead levels in children. Here we break down where the numbers on these instances come from and what they’re missing.

Data Collection

The Rhode Island Lead Poisoning Prevention Act requires health care providers that receive state money to test children under the age of six for elevated blood lead levels (BLLs). It also requires them to report the results to the Department of Health (DOH). The DOH manages the data in the Lead Elimination Surveillance System.

What Data are Public?

Under the Rhode Island Access to Public Records Act (APRA), the data reported to the DOH constitute public records.

In order to protect the privacy of confidential medical records, these data are reported in the aggregate, meaning that rather than releasing every blood lead test result that it receives, the DOH instead groups the results in a number of ways.

First, the DOH uses the reference point of 5 micrograms per deciliter to group BLL data, because 5 micrograms per deciliter is the reference point at which the Center for Disease Control (CDC) identifies “children with blood lead levels that are much higher than most children’s levels.” (Children between ages 1 and 5 with BLLs greater than 5 micrograms per deciliter are in the 2.5 percentile nationally.) Five micrograms per deciliter is also the point at which a public health response is triggered in Rhode Island.

Second, when the DOH reports any medical data in the aggregate, it suppresses all counts fewer than five in order to protect individual privacy. For example, if four children in one town are reported to have elevated blood lead levels, the DOH would not include that in a data release. However, if six children have elevated blood lead levels, then that data would be reported.

Third, the DOH reports both the incidence and prevalence of elevated BLLs in children. Incidence rates refer to the number of children who tested for a BLL greater than 5 micrograms per deciliter for the first time within the past year. Prevalence rates refer to the number of children who have BLLs greater than 5 micrograms per deciliter over the course of the year.

Prevalence of BLL ≥ 5 micrograms per deciliter by town, 2012-2018

Incidence and prevalence of BLL ≥ 5 micrograms per deciliter statewide, 2002-2018

Blood Lead Levels Lower Than 5

Although 5 micrograms per deciliter is the reference level at which the State initiates a public health response, scientists have long held that there is no known safe level of lead in the blood. While the DOH had previously denied my requests for data on the number of children with BLLs greater than 0 but lower than 5, I finally received these data for the year 2019.

You can find the related requests via the links to the right of this article. If you get data for your own state, please let us know at via email.

Image via Geraint Rowland via flickr under CC BY-NC 2.0