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Original Investigation |

Blood Lead Concentrations and Children’s Behavioral and Emotional Problems: A Cohort Study

Jianghong Liu, PhD1,2; Xianchen Liu, MD, PhD3,4; Wei Wang, PhD5; Linda McCauley, PhD6; Jennifer Pinto-Martin, PhD1,2; Yingjie Wang, MS1; Linda Li, BA1; Chonghuai Yan, PhD7; Walter J. Rogan, MD8
[+] Author Affiliations
1School of Nursing, University of Pennsylvania, Philadelphia
2School of Medicine, University of Pennsylvania, Philadelphia
3School of Medicine, Indiana University, Indianapolis
4School of Public Health, Shandong University, Jinan, China
5Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
6Nell Hodgson School of Nursing, Emory University, Atlanta, Georgia
7Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiaotong University School of Medicine, China
8National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland
JAMA Pediatr. 2014;168(8):737-745. doi:10.1001/jamapediatrics.2014.332.
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Importance  The association between lead exposure and children’s IQ has been well studied, but few studies have examined the effects of blood lead concentrations on children’s behavior.

Objective  To evaluate the association between blood lead concentrations and behavioral problems in a community sample of Chinese preschool children with a mean blood lead concentration of less than 10 µg/dL.

Design, Setting, and Participants  A prospective cohort study was conducted at 4 preschools in Jintan, Jiangsu province of China. Participants included 1341 children aged 3 to 5 years.

Exposures  Lead.

Main Outcomes and Measures  Blood lead concentrations were measured in children aged 3 to 5 years. Behavioral problems were assessed using Chinese versions of the Child Behavior Checklist and Caregiver-Teacher Report Form when children were aged 6 years.

Results  The mean (SD) blood lead concentration was 6.4 (2.6) µg/dL, with the 75th and 90th percentiles being 7.5 and 9.4 µg/dL, respectively. General linear modeling showed significant associations between blood lead concentrations and increased scores for teacher-reported behavioral problems. A 1-µg/dL increase in the blood lead concentration resulted in a 0.322 (95% CI, 0.058 to 0.587), 0.253 (95% CI, 0.016 to 0.500), and 0.303 (95% CI, 0.046 to 0.560) increase of teacher-reported behavior scores on emotional reactivity, anxiety problems, and pervasive developmental problems, respectively (P < .05), with adjustment for parental and child variables. Spline modeling showed that mean teacher-reported behavior scores increased with blood lead concentrations, particularly for older girls.

Conclusions and Relevance  Blood lead concentrations, even at a mean concentration of 6.4 µg/dL, were associated with increased risk of behavioral problems in Chinese preschool children, including internalizing and pervasive developmental problems. This association showed different patterns depending on age and sex. As such, continued monitoring of blood lead concentrations, as well as clinical assessments of mental behavior during regular pediatric visits, may be warranted.

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Teacher-Reported Internalizing Problem Scale Scores Among Children Whose Blood Lead Concentration Was Measured at Ages 4 and 5 Years

A, Male, aged 5 years. B, Female, aged 5 years. C, Male, aged 4 years. D, Female, aged 4 years. The solid lines present the fitted spline curve of behavioral problem scale scores by blood lead concentration with adjustment for individual variables in the model. P values of testing significance were determined using the F test. To convert blood lead concentration to micromoles per liter, multiply by 0.0483.

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