Identifying High-Risk ZIP Codes for Childhood Lead Exposure: A Statewide ZCTA-Level Priority List for NorthCarolina.

<h3>Background</h3><p dir="ltr">Research has consistently shown that there is no safe blood lead level (BLL) for children. Despite progress in lead poisoning prevention, lead exposure remains a persistent threat to the health and neurological development of children. To identify high-risk ZIP codes for use by families and health care providers for the entire state of North Carolina, we developed a risk model using ZIP Code Tabula­tion Area (ZCTA)-level census data.</p><h3>Methods</h3><p dir="ltr">We obtained all available BLL testing data from the North Carolina Department of Health and Human Services for the years 2010–2015 via data use agreement. We fit a multivariable regression model with the <i>ZCTA-level mean of log normalized BLLs</i> as the de­pendent variable and <i>ZCTA-level census data for known risk factors of childhood lead exposure</i> as predictors. We used this model to create a priority risk categorization.</p><h3>Results</h3><p dir="ltr">We organized ZCTAs into 20 quantiles, or priority risk categories, that can be used in local and statewide screening programs. The first six (of 20) quantiles were identified as particularly high-risk areas for childhood lead exposure.</p><h3>Limitations</h3><p dir="ltr">Because BLL testing is not universal, the BLL testing data used in this study are likely biased toward those most at risk for lead exposure.</p><h3>Conclusion</h3><p dir="ltr">This study demonstrates the utility of ZCTA-level census data in identifying high-risk ZIP codes for childhood lead exposure, which can be used to ensure that the highest-risk children are tested in a timely manner. This approach can be replicated to address lead exposure nationally.</p>