v>EPA Indicators of Environmental Health Disparities: Blood Lead Levels About the Indicators of Environmental Health Disparities EPA's indicators of environmental health disparities aim to illustrate disparities in key environmental and public health conditions across race/ethnicity and socioeconomic status, as well as the relationship between these health outcomes and the work of EPA programs. This project was created in direct response to EPA's 2022-2026 Strategic Plan. These indicators are intended solely as an informational tool and are not intended to be the basis for agency decision making. EPA does not, consistent with applicable laws, distribute governmental benefits or burdens based on race, color, national origin, or sex. Background Information Lead is a naturally occurring metal in the earth's crust, but it is highly toxic, particularly to young children. Lead is both neurotoxic, impacting cognitive and behavioral development and function, as well as cardiotoxic, raising the risk of cardiovascular disease, primarily in older adults.1 Historically, lead has been used in gasoline, ceramic products, paints, metal alloys, batteries, and solder production. Lead can be found inside our homes - on walls coated with lead-based paint, and in everyday consumer products like toys, ceramics, solders, gasoline, and batteries.2 Lead exposure occurs primarily through ingestion. Ingestion of lead paint (e.g. peeling paint or lead dust) is the route of highest exposure for children, and overall, one of the most common causes of lead poisoning. Additionally, ingestion can occur through geophagy (eating soil), exposure to air pollution consuming non-food items, or frequent hand-to-mouth activity. Since babies and young children often put their hands and other objects in their mouths, they are more highly exposed to ingesting lead from dust or soil. Contaminated food, herbs and spices, cosmetics, and cultural items can also result in the ingestion of lead, as can contaminated drinking water, as lead can leach into drinking water through corrosion of lead-containing pipes and plumbing fixtures. It can pollute our air and soil through the combustion of aviation fuels, boat fuel, farm equipment and other industrial releases. Lead exposure is a concern for both urban and rural communities, both of which may have older housing stock with multiple potential sources of lead exposure. There is no safe level of lead exposure. The health effects of lead do not vary based on how individuals are exposed to lead (i.e. inhalation or ingestion), but the clinical effects of lead are more pronounced for some organ systems at low levels than others.3 Children, infants, and fetuses are most vulnerable to these effects of lead and even very low levels of lead in children's blood have been linked to adverse effects on intellect, concentration, and academic achievement.1,4 Neurotoxic effects from lead exposure also impact adults; however, it is unclear if these exposures are related to exposure during adulthood, exposure during periods of nervous system development, or due to the cumulative effects of lifelong exposure. Lead is also known to cause renal, cardiovascular, hematological, immunological, developmental, and reproductive effects in adults. In older adults, exposure to lead can lead to decreased kidney function, reproductive effects in men and women, and cardiovascular effects.5 Despite progress in reducing lead exposure, some communities are disproportionately exposed to lead —data show disparities in exposure by sociodemographic characteristics and geographic location.6,7,8,9 This differential exposure then contributes to disparities in blood lead levels: for example, Black children have persistently been found to have higher blood lead levels than non-Hispanic white children and children from lower income households have higher blood lead levels than those from higher income 1 ------- households.10 Reducing exposure to lead and associated health impacts begins by identifying lead sources and risk factors at the local level, improving the screening, identification and monitoring of lead exposed children, and targeting services and resources to localities at greatest risk. For more information about lead exposure and its associated risks visit the EP.A;s Learn about Lead landing page. Figure 1. Blood Lead Levels by Race and Ethnicity Median Blood lead levels (ng/dL) 2.0 I Non-Hispanic Asian 1.04 Non-Hispanic White 0.76 I Non-Hispanic Black 0.71 I Other Race - Including Multi-Racial 0.71 | Mexican American 0.62 I Other Hispanic 0.54 0 2000 2004 2008 2012 2016 2018 Data Note: Data points for this indicator are collected in 2-year windows. This graph plots each value in its second year. 2 ------- Figure 2. Blood Lead Levels in Children Ages 1-5 by Race and Ethnicity Median Blood lead levels (ng/dL) 3.0 2.5 2.0 1.5 1.0 0.5 Non-Hispanic Black 0.87 I Mexican American 0.7 I Other Race - Including Multi-Racial 0.7 Non-Hispanic White 0.66 I Other Hispanic 0.57 2000 2004 2008 2012 2016 Data Note: Data points for this indicator are collected in 2-year windows. This graph plots each value in its second year. 3 ------- Figure 3. Disparities in Biood Lead Levels by Race arid Ethnicity Median Blood lead levels (ng/dL) 2.0 1.5 1.0 0.5 I Non-Hispanic Asian 1.04 I Overall average* 0.73 All other races and ethnicities 2000 2004 2008 2012 2016 2018 Data Note: Data points for this indicator are collected in 2-year windows. This graph plots each value in its second year. The "overall average" line includes other racial and ethnic groups not shown in the other charts. 4 ------- Figure 4. Disparities in Biood Lead Levels in Children Ages 1-5 by Race and Ethnicity Median Blood lead levels (ng/dL) 3.0 2.5 2.0 1.5 1.0 0.5 Non-Hispanic Black 0.87 I Overall average* 0.69 All other races and ethnicities 2000 2004 2008 2012 2016 Data Note: Data points for this indicator are collected in 2-year windows. This graph plots each value in its second year. *The "overall average" line includes other racial and ethnic groups not shown in the other charts. 5 ------- Figure 5. Blood Lead Levels by Poverty Level Median Blood lead levels (ng/dL) 2.0 1.5 1.0 0.5 11 to 2 times the Poverty Level 0.76 Over 2 times the Poverty Level 0.72 I Below the Poverty Level 0.71 2000 2004 2008 2012 2016 2018 Data Note: Data points for this indicator are collected in 2-year windows. This graph plots each value in its second year. 6 ------- Figure 6. Blood Lead Levels in Children Ages 1-5 by Poverty Level Median Blood lead levels (ng/dL) 3.0 2.5 2.0 1.5 1.0 0.5 Below the Poverty Level 0.85 1 to 2 times the Poverty Level 0.67 Over 2 times the Poverty Level 0.6 2000 2004 2008 2012 2016 Data Note: Data points for this indicator are collected in 2-year windows. This graph plots each value in its second year. What These Charts Show These charts show the median11 levels of lead in the blood in micrograms per deciliter (ng/dL) of the U.S population from 1999 to 2016 (for children ages 1-5) and 2018 (for all ages), respectively, across race, ethnicity, and socio-economic status (SES). Overall, for both children and adults, across race, ethnicity, and SES, median blood lead levels have declined since 1999. • Non-Hispanic Black children ages 1-5 years have the highest median blood lead (0.87 ng/dL) when compared to the total median blood lead levels of children ages 1-5 (0.69 ng/dL) and all other races and ethnicities (Figure 4). • Children ages 1-5 in households that were below the poverty level,121 to 2 times the poverty level, and over 2 times the poverty level had median blood lead levels of 0.85, 0.67, and 0.6 Hg/dL respectively (Figure 6). This data reveals that Non-Hispanic Black children and children below the poverty level maintain the highest median blood lead levels. • Non-Hispanic Asian populations (1.04 ng/dL) had the highest blood lead levels, compared to the overall average median blood lead levels (0.73 ng/dL) and all other races and ethnicities (Figure 3). • The median blood lead level for populations in households over two times the poverty level was 0.72 ng/dL, the median for populations in households 1 to 2 times the poverty level was 0.76 Hg/dL, and the median for populations in households below the poverty level 0.71 ng/dL (Figure 7 ------- 5). Populations in households that were 1 to 2 times the poverty level thus had the highest blood lead levels. U.S. children's blood lead levels (BLL) show significant reductions and progress in recent decades. The BLL data for this indicator was collected by the Centers for Disease Control and Prevention's (CDC's) National Center for Health Statistics (NCHS) through the National Health and Nutrition Examination Surveys (NHANES). While NHANES is designed to provide nationally representative information for the general U.S. population, this dataset is a relatively small sample compared to the United States and may not reflect the highest children's BLLs collected in state surveillance programs.13,14 Thus, consideration of both national and state/local blood lead level data is important for understanding progress and remaining needs to further address lead exposures in the U.S. For more information about this dataset, see the technical documentation. What These Charts do not Show While these charts provide valuable data that may help determine and identify vulnerable communities, they do not reveal the underlying factors contributing to disparities in lead exposure across ages, races, ethnicities, or socioeconomic statuses. Although lead exposure can affect anyone, the data reveals that certain groups, particularly Non-Hispanic Asian populations, Non-Hispanic Black children and children below the poverty level, experience higher levels of lead exposure compared to others. However, the graphs do not show the specific environmental, social, and economic factors that may exacerbate these disparities, such as housing quality and occupational conditions. It is critical to understand these broader factors to develop targeted strategies that address and mitigate inequities in lead exposure. Relevant EPA Activities EPA contributes to a goal of eliminating disparities in childhood blood lead levels as an integral part of reducing lead exposure for all populations.1 Federal and state regulatory actions have reduced the amount of lead in air, soil, drinking water, food, paint, and other sources. This progress, however, has not been equally realized across the United States, and lead exposure continues to be a top childhood environmental health problem that disproportionately affects communities of color and low-income populations. In 2022, the EPA published its Strategy to Reduce Lead Exposures and Disparities in U.S. Communities. The EPA's goals include reducing community exposure to lead sources in homes and facilities with lead-based paint, drinking water, soils, and ambient air emissions; identifying communities with high exposure and improving health outcomes; communicating with stakeholders; and supporting and conducting critical research to inform efforts to reduce lead exposure and related health effects. While the EPA is enacting these actions to reduce blood lead levels, several factors contribute to blood lead levels that cannot be addressed through EPA regulatory activity and programs. Addressing lead exposure requires a whole of government approach, which is currently coordinated across federal agencies—including the National Institutes of Health, the Department of Housing and Urban Development, the Centers for Disease Control and Prevention, and more—through the Federal Lead Action Plan. It also requires partnerships with state, local and Tribal governments and coordination with community organizations, doctors, and public and community health experts. Offices across EPA are engaged in activities to reduce blood lead levels and reduce blood lead level disparities across race/ethnicity and socio-economic status. Some of these key activities include: • Lead pipe replacement: In October 2024, EPA announced the finalized improvements to the Lead and Copper Rule to better protect communities from lead in drinking water. The proposed rule would require the vast majority of water systems to replace lead service lines in the U.S. within 10 years. The proposed rule also includes identification of legacy lead service lines, 8 ------- improvements to tap sampling, a lower lead action level, and strengthened protections to reduce exposure. EPA is also investing $15 billion through the Bipartisan Infrastructure Law to identify and replace lead service lines throughout the nation. The Bipartisan Infrastructure Law also dedicates $11.7 billion to projects that improve drinking water quality, including reducing lead in drinking water. These funds must be provided to disadvantaged communities15 as grants or forgivable loans. • Reducing exposure to lead in soil: EPA manages lead contamination at Comprehensive Environmental Response, Compensation and Liability Act (CERCLA, or "Superfund") sites, brownfield sites, and Resource Conservation and Recovery Act (RCRA) Corrective Action Facilities. In fiscal year 2024, EPA completed 63 Superfund cleanup actions, and Brownfields grant recipients completed 63 cleanup actions—including in or near disadvantaged communities—that addressed lead contamination (lead is the environmental contaminant most reported by EPA Brownfields cleanup grant recipients). To strengthen these efforts, in January 2024, EPA announced updates to guidance for addressing lead in residential soil at Superfund sites and RCRA corrective action facilities, lowering recommended screening levels and strengthening guidance for investigating and cleaning up lead-contaminated soil. • Lead paint inspection in communities with EJ concerns: In June 2023, EPA published the Environmental Justice Toolkit for Lead-Based Paint Enforcement Programs, which includes strategies for developing partnerships, conducting community engagement, maintaining ongoing communication with the communities where enforcement activities are planned or ongoing, and methods for how to target inspections in high-risk communities, including areas with suspected or confirmed lead service lines, pre-1978 housing stock, or proximity to high ambient or soil- based lead contamination. • Leaded aviation fuel endangerment finding: In October 2023, EPA issued a final determination that emissions of lead from aircraft that operate on leaded fuel cause or contribute to air pollution which may reasonably be anticipated to endanger public health and welfare. With this final determination, EPA and the Federal Aviation Administration (FAA) have begun work to consider regulatory options to address lead emissions from aircraft engines and will announce timelines as soon as possible. EPA and FAA will work in partnership and engage all interested stakeholders and the general public as the two agencies develop their separate regulatory actions. • Dust-Lead Hazard Standards and Post Abatement Clearance Levels: In October 2024, EPA finalized stronger requirements for the dust-lead hazard standards and post abatement clearance levels, which govern how to identify and clean up lead-based paint hazards in pre- 1978 homes and childcare facilities. Together, these regulations will reduce the potential lead exposures of approximately 250,000 to 500,000 children under age six per year. • Pediatric Environmental Health Specialty Units (PEHSUs): EPA supports the work of the PEHSUs through continued funding and programmatic support to educate health care providers on prevention, diagnosis, management and treatment of lead exposure. • Lead safety documents and outreach materials: EPA provides a range of public education materials on lead exposure for families, schools, daycare facilities and more. This is just a small sampling of EPA's recent activities aimed at reducing lead exposure. For a robust accounting of EPA's lead-related work, along with the work of our sister federal agencies, explore the recent Progress Report on the Federal Lead Action Plan. 9 ------- For further information on indicators related to environmental and human health, explore EPA's Report on the Environment, and for further information on indicators related to children's environmental health, explore EPA's America's Children and the Environment (ACE) report. 10 ------- References 1) U.S. Environmental Protection Agency (U.S. EPA). (2013a). Integrated Science Assessment (ISA) for Lead (Final Report, Jul 2013). https://cfpub.epa.gov/ncea/isa/recordisplay.cfm?deid=255721 2) Agency for Toxic Substances and Disease Registry. (2017). Case Studies in Environmental Medicine (CSEM): Lead Toxicity, https://www.atsdr.cdc.gov/csem/leadtoxicitv/cover-page.html 3) Agency for Toxic Substances and Disease Registry (ATSDR). (2020). Toxicological profile for Lead. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. http://wwwn.cdc.gov/TSP/ToxProfiles/ToxProfiles.aspx?id=96&tid=22. 4) Nadakavukaren, A. (2000). Our global environment: A health perspective. Fifth edition. Prospect Heights, IL: Waveland Press, Inc. 5) U.S. Environmental Protection Agency (U.S. EPA). (2013b). Learn about Lead. US EPA. https://www.epa.gOv/lead/learn-about-lead#effects 6) Hanna-Attisha M., LaChance J., Sadler R.C., and Schnepp A.C. (2016). Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A spatial Analysis of Risk and Public Health Response. American Journal of Public Health. 106(2):283-290. https://ajph. aphapublications.org/doi/10.2105/AJPH. 2015.303003 7) Roberts E.M., Madrigal D., Valle J., King G., Kite L. (2017) Assessing Child Lead Poisoning Case Ascertainment in the US, 1999-2010. Pediatrics. 138(5). https://doi.org/10.1542/peds.2Q16- 4266 8) Xue, J., Zartarian, V., Tornero-Velez, R., Stanek, L. W., Poulakos, A., Walts, A., Triantafillou, K., Suero, M., and Grokhowsky, N. (2022). A Generalizable Evaluated Approach, Applying Advanced Geospatial Statistical Methods, to Identify High Lead Exposure Locations at Census Tract Scale: Michigan Case Study. Environmental health perspectives, 130(7): 77004. https://doi.org/10.1289/EHP97Q5. 9) Zartarian, V., Xue, J., Poulakos, A., Tornero-Velez, R., Stanek, L., Snyder, E., Helms Garrison, V., Egan, K., and Courtney, J. (2024). A U.S. Lead Exposure Hotspots Analysis. Environmental Science & Technology\ 58(7): 3311-3321. https://pubs.acs.org/doi/10.1021/acs.est.3cQ7881. 10) Egan et al. (2021). Blood Lead Levels in U.S. Children Ages 1-11 Years, 1976 - 2016. Env. Health Pers., 129(3). https://doi.org/10.1289/EHP7932 11) The median is the value in middle of a sorted ascending or descending set of data. It is used in this context because the distribution of blood lead levels in a population tends to be skewed, and thus a median provides a better representation of the typical blood lead level. 12) Following the Office of Management and Budget's (OMB) Statistical Policy Directive 14. the Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who is in poverty. If a family's total income is less than the family's threshold, then that family and every individual in it is considered in poverty. The official poverty thresholds do not vary geographically, but they are updated for inflation using the Consumer Price Index (CPI- U). For more information, see: How the Census Bureau Measures Poverty. 13) Stanek, L.W., Xue, J., Zartarian, V.G. et al. Identification of high lead exposure locations in Ohio at the census tract scale using a generalizable geospatial hotspot approach. J Expo Sci Environ Epidemiol 34, 718-726 (2024). https://doi.org/10.1038/s41370-024-00666-x 14) Xue J, Zartarian V, Tornero-Velez R, Stanek LW, Poulakos A, Walts A, Triantafillou K, Suero M, Grokhowsky N. A Generalizable Evaluated Approach, Applying Advanced Geospatial Statistical Methods, to Identify High Lead Exposure Locations at Census Tract Scale: Michigan Case Study. Environ Health Perspect. 2022 Jul;130(7):77004. doi: 10.1289/EHP9705. Epub 2022 Jul 27. PMID: 35894594; PMCID: PMC9327739. 11 ------- 15) Most EPA grant programs identify 'disadvantaged communities' using the White House Council on Environmental Quality's Climate and Economic Justice Screening Tool (CEJST) and/or EPA's EJScreen Supplemental Indexes, in addition to any statutorily required factors. For projects funded through the Inflation Reduction Act, EPA defined disadvantaged by a specific set of criteria that expressly reflects the Agency's efforts to distribute funds based on race-neutral criteria. For more information on this criteria, see this webpage. United States Environmental Protection Agency 1200 Pennsylvania Avenue, NW Washington, DC 20460 EPA 231R24002 December 2024 www.epa.gov 12 ------- |