linking childhood lead poisoning and developmental disabilities … · 2011. 12. 6. · linking...
TRANSCRIPT
Linking Childhood Lead Poisoning and Developmental Disabilities
in FloridaState EPHT Team
Greg Kearney, RS, MPHEpidemiologist, Project Manager
Chris DuClos, MSGIS Manager
David R. Johnson, MD, MS, DABT, FACOEMPrincipal Investigator
University of MiamiDevelopmental Epidemiology
TeamKeith G. Scott, Ph.D.
Marygrace Yale Kaiser, Ph.D.Carrie Lazarus, M.S.Tony Gonzalez, B.A.
Trading Partner Acknowledgement
The studies are conductedunder an agreement with the
Florida Department of Education.
Aims of the DET
1. Assist in planning for the provision of services.
2. Help identify groups that would benefit from the provision of early intervention.
3. Help identify conditions that lead to the need for special education services.
The Florida Childhood Lead PoisoningPrevention Program (CLPPP)
STATEWIDE BLOOD LEAD SURVEILLANCE
CLPPP began conducting statewide blood lead surveillance in 1993.
Data is housed at the Florida Department of Health.
Blood lead level results are entered, checked for quality, and merged to the main database.
Exposure Data Set
Patient Information(Name, Date of Birth, Ethnicity, Race, Gender, Address, Medicaid #, Age at Test)
Provider Information (Name, Address)
Lab Information(Name, Address)
Test Information(Report Type, Test Type, Date of Blood Draw, Date Sample Received, Date Sample Reported, Result – Blood Lead Level)
Outcome Data Set
• Demographics (school number, district number, race/ethnicity, sex, dob, grade, native language, free lunch eligibility)
• Exceptionality (Disability Classification) (primary exceptionality: Mental Retardation, Behavior Problems, Autism)
Linked Data Set
FL Birth Records
FL S
choo
l Rec
ords
2002-20032001-20012000-20011999-20001998-19991997-19981996-19971995-19961994-19951993-19941992-1993
XXXXXXXXXXX
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
XXXXXXXXXXX
FL Birth Records: 139,000-196,000 records/yr
FL Public School Data: 2.3-2.8 million records/yr
New Linkage withExposure Data
Birth/School/CLPPPBirth
Data (Geocoded)CLPPP
Data (Geocoded)
Birth/SchoolData
Birth/CLPPP/School Data (Geocoded)
Birth/CLPPPData (Geocoded)
Final AggregatedData set
Data LinkageFirst NameLast Name
Data of BirthMother’s Name
IdentifiersData
Individual Blood Lead Data
Individual Disability Data Absolute andProbabilistic
Linkage
AggregatedDisability RatesBy Blood Level
Relative Risk andConfidence Intervals
Tabulated and Graphedresults
GIS Map Data(Rate of Lead AF of
Disability)
GIS Map – ToxicRelease Inventory
Data
Produce CombinedGIS Map
Expected Products
Linked Disability/Exposure Data SetControlled for Major Confounders
e.g. Parental EducationBirthweight Education
Gestational Age
Expected ProductsControlled Study of Lead Exposure
Dose/Response RelationshipBlood lead level and disability rates
Develop map ofvalidated high-risk areas based on
disability/exposure
##### # ### ## ## ## #
# ####
# #
#
##
##
#
#
##
##
###
##
#
####
#
#
##
#
# ####
###
### ###
##
#### #
##
##
#
# #
####
# #
#
##
#
##
#
##
###
###
###
###
##
#
##
#
#
#
## #
####
#
#
##
##
##
#
# ###
#
#
#
#
#
##
# ####
#
##
## ##
#
####
## ###
#
# #
#
#
##
#
##
#
##
##
##
##
##
#
##
#
#
######
#
#
#
#
#
#
## #
##
#
###
#
#
#
#
#
#
### #
#
#
#
## ###
#
#
#
#
##
#
#
#
#
#
#
##
### #
# ###
#
##
##
#
#
# #
# ###
#
# ###
#
###
#
#
##
####
#
# #
#
#
### #
#
#
#
#
#
#
#
#
#
#
#
###
#
#
###
#
###
## #
#
####
# ###
#
##
###
###
##
#####
###
# ##
#
# ####
#
#
#
#
#
#
###
#
# ## #
#
#
#
#
####
#####
##
#
### #
#
##
#
##
#
###
#
##
#
#
#
## #
#
##
#
#
##
#
#
##
##
####
##
# #
#
##
#
###
#
##
#
##
#
##
#
#
#
####
#
# #
#
## ##
#
##
#
#
#
#
#
#
#
#
#
#
# #
##
##
#
###
#
# ## #
#
#
#
#
##
###
#
#
#
#
##
#
#
##
# ## ##
#
#
#
# #
#
##
##
###
###
##
## ##
#
#
#
#
##
#
##
#
# #
##
#
#
####
##
#
# ###
##
####
#
#
##
##
## #
#
#
#
##
##
### ###
#
#
#
#
#
#
##
###
###
#
#
#
#
#
#
#
##
###
#
##
###
##
#
#
#
##
##
#
###
## #
#
##
##
#
#
#
#
#
#
#
#
####
#
#
#
#
##
#
#
#
##
#
##
##
###
##
##
#
#
#
###
#
#
#
###
##
#
# ##
#
##
##
#
#
#
##
##
###
##
##
#
###
##
#
#
#
#
#
# #
#
#
#
#
##
##
##
#
##
#
##
#
#
#
#
#
##
#
###
#
#
#
#
#
#
#
#
##
## #
# ####
#
#
#
##
## ##
#
#
#
#
#
#
#
# ## #
#
##
##
##
# ####
#
#
#
#
#
#
#
#
#
#
#
##
##
## #
##
# #
##
##
#
#
###
#
##
#
#
##
#
####
#
#
#
#
#
# #
#
##
#
##
#
#
#
#
#
#
## #
######
#
#
##
#
#
#
##
##
##
#
###
#
#
###
#
#
#
#
##
#
#
#
### #
#
#
#
#
###
#
#
##
#
##
#
##
#
#
###
#
#
#
#
#
#
#
#
#
#
###
# #
#
#
##
#
## #
##
#
#
#
##
#
##
#
#
#
#
#
#
##
#
#
#
#
##
##
#
#
#
#
###
#
#
#
##
#
#
#
#
#
##
##
##
#
###
#
###
#
#
#
###
## #
##
#
####
#
# #
#
#
##
#
#
##
###
##
#
#
#
#
#
#
##
#
#
#
##
###
#
#
##
#
#
##
#
#
#
#
##
##
#
#
## #####
#
#### #
#
#
#
#
##
#
#
#
#
#
# ####
###
#
#
#
#
#
#
#
#
#
###
#
##
#
###
#
#
##
#
#
#
##
### #
#
#
#
###
#
#
# #
#
#
#
###
#
#
#
#
#
##
#
#
##
#
# ###
#
# ##
#
#
#
#
##
#
#
#
#
##
#
#
#
#
#
#
#
##
#
#
#
#
#
#
#
#
#
#
## ###
##
Universal Screening Areas for Childhood Lead Poisoning
• Screening areas based on older housing
All Florida county maps on the internet
e.g. Miami-Dade County
http://www.doh.state.fl.us/environment/community/lead/CountyMap.html