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The attributable annual health costs of U.S. occupational lead poisoning.

ABSTRACT: U.S. occupational lead standards have not changed for decades, while knowledge about lead's health effects has grown substantially.The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages.I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures.I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures.Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.

SUBMITTER: Levin R

PROVIDER: S-EPMC4984972 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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The attributable annual health costs of U.S. occupational lead poisoning.

Levin Ronnie R

International journal of occupational and environmental health 20160401 2

<h4>Background</h4>U.S. occupational lead standards have not changed for decades, while knowledge about lead's health effects has grown substantially.<h4>Objective</h4>The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages.<h4>Methods</h4>I combined data voluntarily reported to NIOSH on the number of high ...[more]

PMID: 27173488

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Project description:Child lead poisoning damages central nervous system, immune, and renal function, and is the longest-standing public health epidemic in U.S. history. While primary prevention is the ultimate goal, secondary intervention is critical for curbing effects among children already exposed. Despite the lowering of child blood lead level (BLL) reference value in 2012 and again in 2021, few changes to secondary intervention approaches have been discussed. This study tested a novel interdisciplinary approach integrating ongoing child BLL-monitoring with education and home mitigation for families living in neighborhoods at high-risk of child lead exposure. In children ages 6 months to 16 years, most of whom had lowest range exposures, we predicted significantly reduced BLLs following intervention. Methods Twenty-one families with 49 children, were offered enrollment when at least 1 child in the family was found to have a BLL > 2.5 µg/dL. Child BLLs, determined by ICPMS, were monitored at 4- to 6-month intervals. Education was tailored to family needs, reinforced through repeated parent engagement, and was followed by home testing reports with detailed case-specific information and recommendations for no-cost/low-cost mitigation. Results Ninety percent of enrolled families complied with the mitigation program. In most cases, isolated, simple-to-mitigate lead hazard sources were found. Most prevalent were consumer products, found in 69% (11/16) of homes. Lead paint was identified in 56% (9/16) of homes. Generalized linear regression with Test Wave as a random effect showed that children’s BLLs decreased significantly following the intervention despite fluctuations. Conclusion Lower-level lead poisoning can be reduced through an interdisciplinary approach that combines ongoing child BLL monitoring; repeated, one-on-one parent prevention education; and identification and no-cost/low-cost mitigation of home lead hazards. Biannual child BLL monitoring is essential for detecting and responding to changes in child BLLs, particularly in neighborhoods deemed high-risk for child lead poisoning Highlights • A novel team-based low-cost mitigation strategy for reducing dangerous lower-range child BLLs is presented.• Pre- and post-mitigation child BLL data from 21 families with 49 children were analyzed.• Consumer products and lead paint were the most frequent lead sources identified and were readily mitigated.• Following ongoing parent engagement, education, and mitigation, significant reduction in children’s BLLs was achieved.• Bi-annual child BLL testing is critical for monitoring possible fluctuations in child lead exposure over time.

Project description:BackgroundHousehold food insecurity, a measure of income-related problems of food access, is growing in Canada and is tightly linked to poorer health status. We examined the association between household food insecurity status and annual health care costs.MethodsWe obtained data for 67 033 people aged 18-64 years in Ontario who participated in the Canadian Community Health Survey in 2005, 2007/08 or 2009/10 to assess their household food insecurity status in the 12 months before the survey interview. We linked these data with administrative health care data to determine individuals' direct health care costs during the same 12-month period.ResultsTotal health care costs and mean costs for inpatient hospital care, emergency department visits, physician services, same-day surgeries, home care services and prescription drugs covered by the Ontario Drug Benefit Program rose systematically with increasing severity of household food insecurity. Compared with total annual health care costs in food-secure households, adjusted annual costs were 16% ($235) higher in households with marginal food insecurity (95% confidence interval [CI] 10%-23% [$141-$334]), 32% ($455) higher in households with moderate food insecurity (95% CI 25%-39% [$361-$553]) and 76% ($1092) higher in households with severe food insecurity (95% CI 65%-88% [$934-$1260]). When costs of prescription drugs covered by the Ontario Drug Benefit Program were included, the adjusted annual costs were 23% higher in households with marginal food insecurity (95% CI 16%-31%), 49% higher in those with moderate food insecurity (95% CI 41%-57%) and 121% higher in those with severe food insecurity (95% CI 107%-136%).InterpretationHousehold food insecurity was a robust predictor of health care utilization and costs incurred by working-age adults, independent of other social determinants of health. Policy interventions at the provincial or federal level designed to reduce household food insecurity could offset considerable public expenditures in health care.

Dataset Information

The attributable annual health costs of U.S. occupational lead poisoning.

Publications

The attributable annual health costs of U.S. occupational lead poisoning.

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