By Kristin Jones
Many Colorado children who are at increased risk for ingesting high quantities of lead aren’t being given a recommended blood test that would show whether they have been exposed, according to an analysis by The Colorado Trust.
State guidelines call for doctors to test young children in low-income households or who are living in housing built before 1978, when lead paint was banned.
But only a fraction of these children have been given a routine blood test that would determine whether they have a high amount of the heavy metal in their blood. The test is inexpensive to administer and is covered by Medicaid.
In 2014, Colorado health care providers tested roughly 24,000 children, according to records collected by the Colorado Department of Public Health and Environment (CDPHE). This testing failed to include many others who may have been exposed to lead through chipped and deteriorating paint in their houses, water or soil polluted by mining or industry.
There are 166,000 Colorado children between the ages of 1 and 6 for whom testing may be recommended because of their families’ income level, according to the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state. Approximately 181,000 children under age 6 live in housing built before 1980, according to Census data. (The Census doesn’t track houses built before 1978, so this is an estimate of how many kids are at risk.)
While some Colorado kids fall under just one of these categories, others count in both—in other words, living in a low-income household in a pre-1978 home—so it’s difficult to obtain an accurate estimate from these two figures. What is certain is that a disproportionate number of those Colorado children who are poor or living in older housing are Hispanic, according to Census data.
For children, exposure to lead—even in small quantities—can damage the brain and nervous system, slow growth and development and result in learning and behavioral problems, including lower IQs and impulsive behavior.
Across the country, poor children are more than three times as likely as their wealthier peers to have elevated blood lead levels, according to the Centers for Disease Control and Prevention. Black children face twice the exposure rates of white children. Health officials attribute these disparities to differences in housing quality, nutrition and environmental conditions.
For communities that are disproportionately affected, lead amounts to a structural barrier to health and success.
Last year’s crisis in Flint, Mich. brought national attention to the contamination of that city’s water with lead, and the poisoning of its residents. In general, Colorado has lower rates of lead exposure than some Rust Belt and East Coast cities. Still, there are pockets of the state where children are exposed at high levels, including parts of Denver and Pueblo.
Records provided to The Colorado Trust by CDPHE also show high rates of lead exposure among children in certain parts of Greeley. Some rural areas of the state have also borne a heavy impact from industry and mining; recent testing in Lake County has revealed relatively high rates of lead exposure among children, according to records from the county’s public health department.
In some of these places, public health officials have been able to pinpoint sources of lead, often because of tests showing that children have been affected.
In Denver, officials have mapped the tests of elevated blood-lead levels to see patterns—many of them in poor and minority neighborhoods. For example, there is a cluster of elevated tests from children living in homes on the far west side of the city near West Colfax, and another cluster in the northeast stretching from Elyria-Swansea down to Whittier. The state currently recommends that all children living in certain Denver zip codes be tested for lead, based in part on the discovery that children were disproportionately affected in those areas.
In Leadville, a strong program of blood-lead testing in children followed the designation of the area as a Superfund site, making it a federal priority for cleanup. Lake County blood-lead nurse Lynn Nickle administers the tests in her own office at the public health department, and can help get families connected with federal funds available for cleanup, or advise them on mitigating lead-paint hazards in their homes.
“We don’t send it to a lab. We get the results here,” says Nickle. In her office in Leadville, she points to the results of her follow-up visits to people’s homes, where she uses a handheld X-ray fluorescence device to find sources of lead: a cast-iron sink; a door frame; old, chipping paint on the walls or windows; soil tracked in from the yard.
In other places, where little testing has been done, there may be little awareness of the potential hazards of deteriorating lead paint or waste from abandoned mines or smelters.
“The point of testing is that you eliminate the exposure source, you eliminate ongoing exposure, which will reduce exposure over time and reduce the impact,” says Michael VanDyke, who leads the environmental epidemiology branch at CDPHE.
“Unfortunately, it takes an event such as Flint to remind people that we still do have lead,” says VanDyke. “This is an opportunity for the media to put that attention on lead, and for public health to take the opportunity to make sure we’re doing what we can to get kids tested.”
The places where health care providers most commonly test children for lead exposure—and where results are reported to the state so that health officials can follow up—doesn’t always correspond to where the risk factors are highest. In 2014, for instance, only 17 children in Mesa County were reported to have been given a blood test, according to CDPHE records. More than 3,000 children under six live in poverty there, and 45 percent of the housing was built before 1980, according to Census data.
In some cases, this may be because providers aren’t offering the recommended tests. In others, the laboratory results weren’t reported to the state, as they should be.
Melissa Maybury, of Grand Junction Diagnostics, said her laboratory had analyzed 489 lead test results in 2014 (and hundreds more in 2015), mostly from pediatricians at the affiliated Western Colorado Pediatric Associates. But public health officials never received those results.
Matthew Newman, the state’s lead surveillance coordinator, said that state health officials noticed the low reported testing rates in Mesa County in the spring, and were working with county health officials to contact providers and laboratories in the area in order to assure compliance.
In the more populous Front Range counties, too, testing is inconsistent from place to place. Doctors in Denver County have done significantly more blood testing than those in Jefferson County—though clusters of children with elevated blood-lead levels have been found in west Denver near the county line. High levels of lead have also been recently discovered in the water in at least 70 Jefferson County schools, according to education news website Chalkbeat.
Mitch Brown, environmental health specialist at Jefferson County Public Health, says he was aware of the low rate of blood-lead testing in the county, and has been working to increase it, with mixed success. Last April, his department planned to host an educational event for physicians and others, with hopes of driving up testing rates. But they had to cancel the event when only one health care provider registered to attend. Brown says the department is planning to take the message directly to providers.
Health care providers in Weld County tested five times more children than those in Pueblo County, which, though less populous, has a higher rate of child poverty and a legacy of industrial pollution.
Lynn Procell of the Pueblo City-County Health Department says that testing increased in Pueblo neighborhoods adjacent to the abandoned Colorado Smelter following a Superfund site designation in late 2014. County health department officials visit the homes of any child with an elevated blood-lead level, and have found that contamination is often unconnected to the smelter pollution—indicating that children living farther away from the Superfund site could also be at risk.
“Nine times out of 10, it’s paint,” says Procell. “It’s older housing.”
Inconsistencies in the level of lead testing from place to place make it difficult for public health officials to know whether children have been hurt by lead contamination discovered in the water or soil.
Last year, for instance, water systems in Larimer and Weld counties that are fed by the Carter Lake Filter Plant near Berthoud discovered high levels of lead in their water from routine tests, performed every three years, as regulations require. Follow-up tests revealed a lingering problem.
As in Flint, the water supply itself wasn’t contaminated with lead, but a change in the water’s pH had made it more corrosive to lead plumbing in people’s houses.
Mark Maddox, the Carter Lake Filter Plant’s manager, said that the plant began adding a corrosion inhibitor to the water. But the chemical takes a while to coat the pipes.
Has the lead in the water shown up in local children’s bloodstreams? That’s unclear.
“We look for those spikes in elevated blood-lead levels,” says VanDyke. “Those are really difficult to find because not all children are tested for lead.”
Health care providers aren’t penalized for failing to test children who are at risk for lead poisoning.
“We really rely on the ‘This is the right thing to do’ approach,” says VanDyke.
That’s enough for some providers.
“We take a lot of pride with having everything available to families that we can,” says Pamela Smith, a nurse at Pediatric Associates, which has offices in Montrose and Delta and rigorously tests its young patients for lead in their blood.
Blood testing by Pediatric Associates helped public health officials identify lead poisoning in their region, including two neighboring families in Delta County whose children had very high blood-lead levels after playing in the backyard. The elevated levels led to investigations at the homes, which identified waste from a previous occupant’s hobby mining activities as the source of contamination. Within several months—still much too slow, from the families’ perspective—the Environmental Protection Agency had cleaned up the site.
For the providers at Pediatric Associates, the incident reinforced the importance of testing kids for lead exposure.
Says Smith: “We all really care about what we do.”