Purpose: The Center for Disease Control has recommended administering a questionnaire at regular office visits of children 6-72 months to determine those children at risk for lead poisoning. Levels are being performed regularly and a level > 10 mcg/dl is considered abnormal. This study was performed to compare lead levels obtained at a rural site, Cabin Creek Health Center (CCHC), Dawes, WV versus those obtained from an urban population, Women & Children's Hospital, Charleston, WV, and determine prevalence. Methods: We performed a review of medical records of 46 patients at CCHC and 47 at Women & Children's Hospital who had completed the assessment of risk questionnaire and who lived in respective areas. Levels were done mostly by finger stick in a period between June 1992 and August 1995. Data in percent ± STD. Mean comparisons performed by student's T-test. A p value of <0.05 was considered significant. Results: We found an average lead level of 6.04 ± 4.03 rural versus 4.55± 2.47 (p = 0.054). According to responses to the questionnaire, 20(43%) children at CCHC were classified as having high risk versus 13 (28%) in Charleston. The questionnaire was effective in identifying children with elevated lead levels. Eleven (50%) high risk rural children had a level > 10 mcg/dl, 2 above 15 mcg/dl versus 2 (15%) of urban children--all less than 15 mcg/dl. We found a significant difference in the means of these two high risk populations: rural 8.71 ± 4.74 versus urban 5.31 ± 3.17 (p= 0.029). Children classified as low risk were very unlikely to have an elevated level. Only 1 patient in the urban low risk population had a level of> 10 mcg/dl. The average of both populations combined was 5.29 ± 3.42 with a prevalence of 15% for a level > 10 mcg/dl.Conclusions: Studies of various areas of the country have shown a prevalence of elevated lead levels between 2.1 and 7% in the general population, with suburban children having significantly lower levels. We found a similar prevalence, 6.38% in the urban population but a higher, 23.9% in this rural site, with a statistical significant difference in the means of both high risk groups. The risk assessment questionnaire was helpful identifying children with high and low levels. It may not be necessary to perform a lead determination in the low risk children if cost is a consideration.
