Trends in Occupational and Adult Lead Exposure in Wisconsin By Henry Anderson, MD Monirul Islam, MD, PhD Wisconsin Division of Public Health Bureau of Environmental and Occupational Health

Objectives Wisconsin Adult Blood Lead Epidemiology and Surveillance (ABLES) Program: Objectives Wisconsin Adult Blood Lead Epidemiology and Surveillance (ABLES) Program: Reduce Wisconsin’s burden of adult lead poisoning Reduce Wisconsin’s burden of adult lead poisoning Track the screened individuals and their BLL over time Track the screened individuals and their BLL over time Early identification of emerging industries and exposures needing technical assistance and education Early identification of emerging industries and exposures needing technical assistance and education

Wisconsin ABLES Programs Activities: The program receives statutorily required laboratory reports of blood lead testing of adult Wisconsin residents aged 16 and older. The program receives statutorily required laboratory reports of blood lead testing of adult Wisconsin residents aged 16 and older. 1. Maintains a database of reported laboratory lead results which is used by all states participating in ABLES; 2. Through employer questionnaires and employee interviews Investigates the circumstances associated with adult blood lead levels greater than 40  g/dL including employer awareness of lead hazards and regulatory requirements;

Wisconsin ABLES Programs Activities (cont.): 3. Provides education about the health effects of lead and regulatory requirements to employers, employees, and the general public and; 4. Refers employers needing technical assistance to the Wisconsin OSHA Consultation Program.

Wisconsin ABLES Program: Partnerships Wisconsin ABLES Program has the following Partnership Programs: Wisconsin OSHA Consultation Program Wisconsin OSHA Consultation Program WI State Laboratory of Hygiene WI State Laboratory of Hygiene Participating Employers throughout Wisconsin Participating Employers throughout Wisconsin WI Childhood Lead Poisoning Surveillance WI Childhood Lead Poisoning Surveillance WI Environmental Public Health Tracking Program WI Environmental Public Health Tracking Program WI Occupational Health and Surveillance Program WI Occupational Health and Surveillance Program

Wisconsin Blood Lead Test Reports:

Age 0-24 µg/dl (%) µg/dl (%) µg/dl (%) µg/dl (%) >=60 µg/dl (%) yrs4,807 (95.0)202 (4.0)28 (0.6) 8 (0.2)10 (0.2) yrs17,940 (93.2)1,056 (5.5)147 (0.8)50 (0.2)54 (0.3) yrs9,949 (94.5)443 (4.2) 87 (0.8) 27 (0.3)17 (0.2) 64+ yrs2,750 (98.6)29 (1.0) 4 (0.2) 1 (0.1)2 (0.1) Total35,446 (94.3)1,730 (4.6)266 (0.7)86 (0.2)83 (0.2) Adult Blood Lead Level by Age WI Residents:

0-24 µg/dl Percent µg/dl Percent µg/dl Percent µg/dl Percent >=60 µg/dl Percent Electronic & Electrical Equip Fabricated Metal Products Primary Metal Industries Construction Industries Rubber & Misc Plastic Products Machinery & Computer Equip All Other Industries Percent of Adult Blood Lead by Employer Standard Industrial Code Classification WI Residents:

Number of Individuals BLL Decreased BLL Increased BLL >50 µg/dl11070%24% BLL >40 µg/dl36062%28% All cases with multiple tests8,96247%33% Change in Blood Lead Level (BLL) Subsequent to Identified Elevated BLL WI Residents:

Wisconsin Blood Lead Reports >39 µg/dl:

Wisconsin Mean Blood Lead (µg/dl) by Year:

Wisconsin ABLES Program: Strengths Can passively track the time trend for individuals in a medical monitoring program and indirectly assess the success of employer efforts to reduce individual lead exposures Can passively track the time trend for individuals in a medical monitoring program and indirectly assess the success of employer efforts to reduce individual lead exposures Provides a means to evaluate the efforts to control and reduce occupational lead exposure Provides a means to evaluate the efforts to control and reduce occupational lead exposure Identify emerging hazardous circumstances and provide information to employees, employers and health care providers Identify emerging hazardous circumstances and provide information to employees, employers and health care providers

Wisconsin ABLES Program: Limitations We should recognize several limitations of this surveillance system. The most important one is due to the passive data collection process, which makes longer gap between the actual data and the reporting. We should recognize several limitations of this surveillance system. The most important one is due to the passive data collection process, which makes longer gap between the actual data and the reporting. It also requires being cautious when interpreting the results due to the following facts: It also requires being cautious when interpreting the results due to the following facts: Underreporting of adult lead poisoning by employees, physicians, and employers Underreporting of adult lead poisoning by employees, physicians, and employers Inadequate health care provider recognition of adult lead poisoning Inadequate health care provider recognition of adult lead poisoning Possible exclusion of at-risk populations from surveillance (e.g. self- employed) Possible exclusion of at-risk populations from surveillance (e.g. self- employed)

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