Long-term
costs of lead poisoning:
How much can New
York save by stopping lead?
July 9, 2003 - for questions
or comments please contact:
Katrina
Smith Korfmacher, PhD[1]
Community Outreach
Coordinator
Environmental Health
Sciences Center, University of Rochester
Katrina_korfmacher@urmc.rochester.edu
(585) 273-4304
“As long as attention focuses on the costs of
lead-paint abatement and ignores the costs of not abating and as long as people
add up the costs of removing paint but not the costs of medical care,
compensatory education, and school dropouts, substantial action is
unlikely.” - Joel Schwartz (1994, p.
105)
INTRODUCTION:
It is easy to be daunted by the
potential costs of making New York’s housing lead-safe. Estimates range between under $1000 and
$40,000 or more per housing unit; national averages are around $7000 per
unit. Although it is harder to quantify
the benefits of eliminating lead from housing, these benefits are real and, over
time, may actually dwarf current remediation costs. A recent study by Landrigan et al. (2002) estimated that the
annual costs of environmentally attributable diseases in American children
total $54.9 billion, of which the vast majority ($43.4 billion) arise from lead
poisoning.[2] By combining medical and economic research,
it is possible to reliably estimate some of these benefits. I have outlined the major potential benefits
of eliminating lead poisoning under several categories: lost future income, neonatal
mortality, health care costs, special education, criminal justice, and the
state infrastructure that currently addresses lead poisoning.
Although I have not addressed this
issue in my cost estimates, it is essential to remember that the costs of lead
poisoning outlined below are borne by all New Yorkers. However, the costs most directly affect
populations that can afford them the least.
In 2001, 95% of the children who tested above 10 µg/dL in New York City
were non-Caucasian (NYC Dept. of Health and Mental Hygiene, 2001). This implies that lead is one of the most
significant issues of environmental justice in this state. While average lead poisoning rates in the
population have indeed declined in recent years (NY Dept. of Health, 2000), the
rate among the poor and minorities could actually be increasing. The publicly available statewide data does
not allow us to investigate this possibility.
I urge that analyses be conducted to explore the trends in poisoning
rates in New York’s oldest and poorest neighborhoods, as this is beyond the
scope of my present analysis.
Please note that this is NOT a
cost-benefit analysis, since I have not considered HOW these reductions in lead
poisoning would be achieved and at what cost.
Rather, I have asked, “what costs would the state of New York avoid on
an annual basis if lead poisoning due to deteriorated housing were
eliminated?” I have made these
calculations for the year 1999, since that is the most recent year for which NY
DOH statistics have been published.
Prior efforts to quantify the impacts of lead
poisoning have focused on lost future income.
Medical research suggests a strong correlation between EBL and lowered
IQ. Economic research shows that lower
IQ results in reduced income earned over a person’s lifetime. Although this may not in fact be the most
significant impact of lead poisoning, it is the best-documented and easiest to
quantify. Schwartz (1994) estimates
that nearly three-quarters of the quantifiable costs of lead poisoning come
from the impact of lowered IQ on earnings potential. Grosse et. al (2002) have recently updated these costs
calculations; their estimates are used below.[3]
|
|
3%
discount rate |
|
Average
avoided IQ loss (points) |
12 |
|
Number
of children (0-6) with BLL over 10 in 1999 |
17,389 |
|
Earnings
loss/IQ point |
$3720 |
|
Total
annual earnings gain ($) |
$776,256,773 |
|
NY
state gain (10% income tax) ($ per year) |
$77,625,677 |
If we assume an average income tax
rate of 10%, these means that NY State is losing nearly $78 million in tax
dollars each year from children’s earning potential being reduced by lead
poisoning. This estimate of benefits
that could be gained by eliminating lead poisoning is conservative for reasons
discussed in Grosse (2002), including the fact that it does not calculate the
effects on children at levels below 10 µg/dL).
Recent research implies that, in fact, the rate of IQ loss is higher at
these low concentrations (Canfield et al., 2003). In addition, the number of children identified with an elevated
blood lead level (over 10) is likely low (see Appendix A).
An alternate means of calculating the lost earning
potential was presented by Landrigan et. al. (2002). These authors used the most recently available national average
blood lead level of 2.7 µg/dL among 5 year old children. They summarize studies that show the severe
impact of lead on reducing IQ at low levels (BLL less than 10). Based on recent research, their estimate
assumed that each 1 µg/dL BLL corresponds to a .25 IQ point loss per child,
which would result in a 2.39% loss of lifetime earnings. Using a growth rate of 1% and a discount
rate of 3%, they calculated the lost earning potential of boys and girls
separately in 1999 dollars. Applying
Landrigan’s national figures to the number of 5 year olds in NY state[4]
implies lifetime earning losses of close to $3 billion per year (Table 1b).
|
|
Loss
of lifetime earnings |
Lifetime
earnings |
Number
of children (5 year olds in 1999) |
Total |
|
Boys |
1.61% |
$881,027 |
123,942 |
1,758,059,600 |
|
Girls |
1.61% |
$519,631 |
123,942 |
1,036,906,097 |
|
Total |
|
|
|
2,794,965,697 |
Thus, population-wide New York state
may be losing nearly $3 billion from each birth cohort of children. In other words, the vast majority of
earnings loss comes from children who are not identified as lead poisoned,
either because their BLL is less than 10 or because they were not tested. In addition, this is probably a conservative
method since the actual BLL in New York state is probably higher than the
national average of 2.7, because of the relatively high percentage of pre-1940
housing in the state. This alternate
method of calculation shows that Table 1a (based on children identified with
BLL over 10 µg/dL) may be conservative by nearly a factor of four.
As mentioned above, Schwartz’s (1994) influential
analysis attributes the majority of childhood lead poisoning reduction benefits
to increased earning potential. The
other significant cost he monetizes is infant mortality (around 16% of total
cost). The EPA included this benefit in
its 1996 Regulatory Impact Analysis (EPA, 1996), estimating a $1,163 benefit
per housing unit abated through avoided neonatal mortality. A 1999 study found a significant increase in
spontaneous abortion rates for women with low to moderate lead exposures
(Borja-Aburto, et al. 1999).
However, the regulatory impact analysis for HUD’s
recent lead paint regulations (US HUD, 1999) argued that 1) the link between
neonatal mortality and maternal blood lead levels below 10 µg/dL is tenuous; 2)
very few pregnant women have blood lead levels above 10 µg/dL; and 3) for those
women with very high lead levels, the cause is likely to be occupational and
thus would not be addressed by remediation.
For these reasons, neonatal mortality was not quantified as a potential
cost in the HUD analysis, nor is it here.
The direct health care costs of lead
poisoning include treatment of severely poisoned children (chelation and
associated costs) and follow-up and monitoring of moderately poisoned children
(lab testing, physician visits, home inspections, etc.). Very few children are chelated each year,
usually when the child’s BLL is above 45.
For example, in New York City in 1995, 163 of the 2727 children with
blood lead levels over 20 were chelated (Green, 1998). The greatest proportion of total health care
costs accrue from direct treatment of children poisoned at levels between 10
and 45 (non-chelated children). These
costs include repeat testing and, at levels over 20, environmental
investigation and hazard control of the children’s homes. Appendix A describes how these costs were estimated. The estimates given below for the costs of
treating lead poisoned children are derived from Kemper et al. (1998).[5]
|
BLL
in µg/dL |
Number
of 0-6 yr olds in NY state in 1999 |
Cost
of follow-up treatment per child (from Kemper, 1998) |
Total
cost per year |
|
10-14 |
11502 |
$55.95 |
$643,537 |
|
15-19 |
3026 |
$55.95 |
$169,305 |
|
20-45 |
2701 |
$782.6 |
$2,113,803 |
|
45-70 |
134 |
$1017.6 |
$136,358 |
|
Over
70 |
28 |
$2625.60 |
$73,517 |
|
Total |
17,392 |
|
$3,136,519 |
Of this these total costs, the majority of the
medical costs are paid for through Medicaid, since a large proportion of the
children who are lead-poisoned are on Medicaid.[6] In addition, all of the environmental
investigation and hazard remediation costs are paid for by the State Department
of Health (based on these estimates, around $959,109 per year). These costs likely underestimate current
medical costs for several reasons: 1)
the Kemper figures are in 1996 dollars; 2) problems (behavioral, learning,
etc.) related to lead poisoning but not directly associated with treatment of
lead may result in additional physician visits; 3) as noted above, the data for
number of poisonings in the state may be significantly low.
In addition to these immediate costs of treatment,
ongoing research suggests a range of additional health effects of lead
poisoning (and related medical costs).
Adult hypertension (elevated blood pressure, with increased risk of
heart attack and stroke) has been linked to a history of childhood lead poisoning
(Kim et al., 1996). If this link is
quantified, it could result in significant additional cost implications of lead
poisoning. However, because of the lack
of data, the HUD analysis cites preventing adult hypertension as a
“non-quantifiable benefit,” along with “improving children’s stature, hearing,
and vitamin D metabolism” (HUD analysis, p. 3-51). A recent study by Landrigan et al. (2002) also did not include
costs of cardiovascular disease because “a preliminary analysis revealed that
these costs were probably minor because of the combined effects of a relatively
weak correlation between childhood and adult blood pressures, the resulting
modes attributable burden of increased cardiovascular disease, and the severe
discounting applied to costs that will arise four or more decades after
exposure to lead.”
Recent studies have linked lead poisoning and
osteoporosis (Escribano et al, 1997; Gruber et al. 1997). Another health cost that has not been
quantified is the link between childhood lead poisoning and increased dental
caries (Moss, 1999). Altogether, such
long-term health costs of chronic conditions may dwarf the direct costs of
treating lead poisoned children.
Medical research strongly supports
the link between lead poisoning and impaired neurobehavioral function. In addition to the IQ effect described
above, elevated lead levels have been associated with “lower class standing in
high school, increased absenteeism, lower vocabulary and grammatical-reasoning
scores, poorer hand-eye coordination, longer reactions times and slower finger
tapping…” (Needleman et al., 1990).
Therefore, lead poisoning likely contributes to children’s need for
special education.
According to Schwartz (1994), 20% of children with
blood lead levels over 25 need special education (assistance from reading
teacher, psychologist or other specialist) for an average of 3 years. In 1998, the average annual cost of special
education was $12,833. Based on these
assumptions, eliminating lead poisoning could save the state over $7,724,371
annually in special education costs.[7]
|
|
|
|
Number
of children, BLL>25 |
1,270 |
|
20%
of children, BLL >25 needing special education for three years |
254 |
|
Cost
of three years of special education |
$38,199 |
|
Total
annual benefit |
$9,706,454 |
This may be a very low estimate,
since recent medical research has shown effects on children’s ability to learn
at levels well below 25 µg/dL. In fact,
recent research has detected significant effects on intelligence at below 10 µg/dL
(Canfield et al., 2003; Lanphear, 2000).
The special education costs in Table 3 are based solely on the
likelihood of a learning disability at BLL over 25 µg/dL. No studies have yet been published on whether
or not children with blood lead elevations under 25 µg/dL incur significantly
more special education costs.
Researchers have suggested that lead poisoning may
contribute to delinquent behavior and violent crime as a function of the
neurobehavioral impacts cited above (Needleman et al., 1996; Nevin, 1999). Given the high societal costs of criminal
activity (costs to victims, incarceration of criminals, etc.) eliminating lead
poisoning could potentially create significant benefits to society. The majority of these benefits are
currently unquantifiable, however a recent study by Needleman makes it possible
estimate the extent of lead’s contribution to juvenile delinquency. Needleman (2002) found that “adjudicated
delinquents were four times more likely to have bone lead concentrations over
25ppm that controls.”[8] However, it is difficult to translate bone
lead levels into blood lead levels. Therefore,
the approach taken here is to assume that 10% of juvenile delinquency may be
attributed to lead poisoning. Based on
Needlman’s work, this appears to be a conservative assumption; however,
additional efforts to quantify the relationship between population-wide blood
lead levels and juvenile delinquency would be helpful. Applying this 10% assumption to the cost of
residential treatment of juveniles alone, savings could range from $12 to 35 million per year.[9]
Table 4: Potential reductions in residential placement of juvenile delinquents
Attributable risk |
Estimated annual benefit based on1998-99 OCFS budget |
Estimated annual benefit based on cost of residential treatment |
.10 |
$12, 343,600 |
$34,544,000 |
The State of New York subsidizes
efforts to educate about, prevent, and respond to cases of childhood lead
poisoning. This ‘state infrastructure’
for childhood lead poisoning would no longer be necessary if lead poisoning
were eliminated, although presumably some infrastructure would remain for
monitoring, etc. Unfortunately, the
costs of this system are very difficult to determine because they are often
parts of larger programs and because a large number of entities is
involved. The elements of this system
are described below and, where possible, cost estimates are given. This infrastructure may be divided into two
parts: public health and environmental health.
New York State’s Department of
Health supports counties’ public health programs, including lead poisoning
prevention, education, and response.
The only part of these monies for which I have an estimate is the
supplemental lead poisoning prevention grants, which Ken Boxley of the
Department of Health estimates at $8 million per year (personal communication,
2002).
In addition to these public health
programs, the state funds environmental health efforts aimed at locating and
remediating lead hazards. The figure
derived above (see health care costs) for environmental investigations is
certainly a very low estimate of the full costs of environmental investigations
($959,105).
Several legal suits have been
brought against municipalities in recent years. While New York City has borne the greatest costs due to legal
liability for lead issues, other municipalities have been successfully sued in
recent years. The settlements to date
have not been a significant cost on a statewide basis, however, there is a
potential for many more suits to be brought in future years.
The estimates given above are all
conservative - the benefits may in fact be higher in each category. In addition, it is important to note that
some of the most costly impacts of lead (including osteoporosis, hypertension,
stroke, and neonatal mortality) cannot be quantified at this time.
It would be inappropriate to give a total of these
potential benefits because the range of uncertainty is not known and because of
the significance of unquantified effects of lead poisoning. However, this table gives a rough sense of
the relative magnitude of the various effects which we can currently
quantify. It also shows where improved
estimates should be sought. I welcome
any comments or suggestions for their improvement.
This summary points to the need for
additional research on the societal costs of lead poisoning. While recent updates have been made on the
effects of IQ loss on earning potential (Landrigan et al., 2002), these costs
may not be of much interest to the state and local governments whose policies
significantly determine lead poisoning prevention efforts. These entities are much more likely to
respond to costs that represent annual budget items for their level of
government, such as Medicaid reimbursement for medical costs, juvenile justice
systems, and special education. The
estimates given for these costs in this paper are likely very conservative. For example, the figure used to calculate
special education costs is based on effects of blood lead elevations that are
very high by today’s standards (over 25).
Especially in light of new research showing IQ effects below 10 µg/dL,
it is essential that these estimates be updated. Any research that could improve the reliability and completeness
of estimating these costs would likely be very useful to making policy
arguments for investing in lead poisoning prevention. Indeed, some day it may be possible to conduct a cost-benefit
analysis that supports significant societal investment in reducing lead hazards
to prevent lead poisoning
Table
5: Summary of the benefits of eliminating lead poisoning in New York State.
|
Benefit |
Estimate
of Annual Benefit |
Comments |
|
Increased
earning potential |
$776,256,773
|
Estimate
based on testing data that may significantly underestimate actual number of
lead poisoning cases; “Landrigan method” suggests $2.8 billion earnings loss
per year. |
|
Neonatal
mortality |
Unquantified |
Difficult
to quantify for both epidemiological and ethical reasons |
|
Health
care – direct treatment |
$3,136,519 |
Does
not include lead-related problems such as behavioral difficulties |
|
Health
care – long term effects |
Unquantified |
Includes
hypertension, stroke, and osteoporosis |
|
Special
education |
$9,706,454 |
Probably
vastly underestimates costs because does not include needs of children with
BLL under 25 µg/dL |
|
Juvenile
Delinquency |
$12,
343,600 |
Range
is $12 to $35 million if one assumes
a 10% attributable risk; due to uncertainty in actual costs of residential
treatment, may be even higher. Does
not include costs other than residential treatment. |
|
Criminal
justice |
Unquantified |
If
effects of lead on juvenile delinquency carry through to adult behavior,
costs could dwarf the juvenile costs. |
|
State
infrastructure |
$8,000,000 |
Rough
estimate of costs of grants to counties for lead prevention work. |
|
Legal
liability of municipalities |
Unquantified |
Only
a small number of cases have been settled to date; however there is a much
larger potential for future cases. |
.
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V.H., I.l Hertz-Picciotto, M.R. Lopez, P. Farias, C. Rios, J. Blanco. 2000.
Blood lead levels measured prospectively and risk of spontaneous
abortion. American Journal of
Epidemiology. 150(9): 590-837.
Canfield,
R.L., C.R. Henderson, D.A Cory-Slechta, C. Cox, T.A. Juski, B.P Lanphear. 2003.
Intellectual impairment in children
with blood lead concentrations below 10 µg per Deciliter. New England Journal of Medicine. 348(16): 1517-1526.
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1996. “TSCA Title IV, Sections s402(a)
and 4040: Target housing and child-occupied facilities final rule regulatory
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Gruber,
H.E., H.C. Gonick, F. Khalil-Manesh, T.V. Sanchez, S. Motsinger, M. Meyer, C.F.
Sharp. 1997. Osteopenia induced by long-term, low- and high-level exposure of
the adult rat to lead. Mineraal & Elecotroyte
Metabolism. 23(2): 645-73.
Kemper,
A.R., W.C. Bordley, and S.M. Downs.
1998. “Cost-effectiveness
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of the Centers for Disease Control and Prevention.” Arch. Pedeiatr. Adolesc. Med.
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Kim,
R., A. Rotnitzky, D. Sparrow, S. Weiss, C. Wager, H. Hu. 1996.
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function: The normative aging study.
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Landrigan,
P.J., C.B. Schechter, J.M. Lipton, M.C. Fahs, and J. Schwartz. 2002.
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110(7): 721-728.
Lanphear,
B.P., K. Dietrich, P. Auinger, C. Cox.
2000. Cognitive deficits
associated with BLLs <10 µg/dL in US children and adolescents. Public Health Rep. 115:521-529.
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M. J.F. Rosen, and I. Clemente. 1999. Clinician follow-up of children screened for
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M.E., B.P. Lanphear, and P. Auinger.
1999. Association of dental
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H.L., J.A. Riess, M. J. Tobin, G.E. Biesecker, J.B. Greenhouse. 1996.
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H.L., A. Schell, D. Bellinger, A. Leviton, E. Allred. 1990. The long-term
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H.L. et al. 2000. Bone lead levels in adjudicated delinquents:
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Needleman,
H.L.. 2002. Bone lead levls in
adjudicated delinquents: A case control study.
Neurotoxicology and Teratology 24: 711-717.
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R. 2000. How lead exposure relates to temporal changes in IQ, violent crime,
and unwed pregnancy.
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success of NY’s efforts to prevent childhood lead poisoning.
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Joel. 1994. Societal Benefits of Reducing Lead Exposure, Environmental
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These calculations use incidence data - only newly ‘confirmed’ cases of poisoning. That is, children who were poisoned in previous years and those for whom there is just one finger stick are excluded (confirmation requires a venous sample or two capillary samples). Although including ALL lead poisoned children would give higher costs estimates, using incidence data allows us to think of the costs calculated as annual additional cost (for example, there is no evidence that a child poisoned during two calendar years will need twice as much special education as one poisoned during one year, so this avoids double-counting children who have elevations over several years).
Data New York City are based on 2001 City Health Department figures included in a 2001 annual report by the New York City Department of Health and Mental Hygiene. I used the incidence data for all children poisoned in 1999 (Figure 1, 8,146) and reduced it based on the data for 2001 (total children poisoned under 18 = 5,638; children under 6 = 4,618) to estimate number of children under 6.
Data through 1999 for the rest of the state have been published by the State DOH (NY DOH, 2000). Neither data set is a complete record of lead-poisoned children (testing rates of 83% in the city (percent of children born in 1998 tested at least once before 3rd birthday) and 62% for the rest of the state for the 1997 cohort) and both provide only aggregate data.
In order to determine average BLL, I looked at several distributions of blood lead level (including New York City and Rochester) and concluded that the average BLL of children who are poisoned (BLL over 10) is around 14 µg/dL.
For several of the calculations, I
needed a finer distribution of blood lead levels. Based on Monroe County’s data, for which a more detailed
distribution was available, I made the following assumptions:
|
|
Number
of children in Monroe County, 1996-2000 |
Proportion
of children in Monroe county |
Projected
distribution for New York State in 1999 |
|
10
to <15 |
5839 |
.66 |
11,502 |
|
15
to <20 |
1536 |
.17 |
3,026 |
|
20
to <45 |
1371 |
.16 |
2,701 |
|
45
to <70 |
68 |
.008 |
134 |
|
Over
70 |
14 |
.0016 |
28 |
|
Total |
8808 |
|
17,391 |
These
assumptions should be updated with the actual distribution of statewide
poisoning levels if and when that data becomes available to the public.
Kemper et al. (1998)[10]
provide a comprehensive overview of costs of follow-up care. Nonetheless, some assumptions were necessary
to interpret which of these costs apply to which level of poisoning. The following assumptions were used:
|
BLL
in µg/dL |
Follow-up
measures and average cost |
Total
cost per child |
Number
children in NY |
Total
cost in New York State in 1999 |
|
10
to <15 |
Diagnostic
testing (venipuncture + lead assay = $23.95) One
additional visit (nurse: $32) |
$55.95 |
11,502 |
$643,537 |
|
15
to <20 |
Diagnostic
testing (venipuncture + lead assay = $23.95) One
additional visit (nurse: $32) |
$55.95 |
3,026 |
$169,305 |
|
20
to <45 |
Diagnostic
testing (venipuncture + lead assay = $23.95, 8 times) Eight
additional visits ($32 each) Environmental
investigation ($335) |
$782.6 |
2,701 |
$2,113,803 |
|
45
to <70 |
Diagnostic
testing (venipuncture + lead assay = $23.95, 8 times) Eight
additional visits ($32 each) Environmental
investigation ($335) Oral
chelation ($235) |
$1017.6 |
134 |
$136,358 |
|
Over
70 |
Diagnostic
testing (venipuncture + lead assay = $23.95, 8 times) Eight
additional visits ($32 each) Environmental
investigation ($335) Intravenous
chelation ($1843) |
$2625.60 |
28 |
$73,516 |
|
Total |
|
|
13,839 |
$3,136,519 |
The state data are likely to
underestimate the prevalence of lead poisoning (see Green, 1998 for examples of
underestimation) for several reasons: they include only new cases, exclude
children who did not get a follow-up test, and children who were never
tested. By way of comparison, Monroe
County data which includes all children (regardless of whether they tested
positive for lead in previous years) and all test (not just confirmed) yields a
total number of poisoning cases nearly four times the state estimate (based on
only new and confirmed cases). This
should be taken into account in interpreting the data.
[1] The author thanks the many people who have commented on this document, especially members of the Rochester Coalition to Prevent Lead Poisoning and Dr. James Campbell. Their assistance has been invaluable. However, the author bears full responsibility for the analysis and data interpretation included below.
[2] Landrigan et al. emphasize that this is a conservative estimate, particularly with respect to lead poisoning, because the costs of special education, criminality, medical follow-up, adult diseases to which lead poisoning may contribute, and environmental remediation are not included. In addition, the calculation is based on the blood lead level of 5 year olds, whereas the average BLL for 2 year olds may be higher. They also note that, by comparison, health costs due to motor vehicle accidents are just over 80 billion per year for the entire population.
[3]This calculation makes several assumptions. Based on Grosse et al. (2002), I assume a net present value loss of $3720 per child for each increase of 1 ug/dL. This figure uses a 3% discount rate. I have calculated the benefits that accrue each year, assuming that there were 17,389 0-6 year olds with first-time elevations above 10 µg/dL in 1999. The number of cases of poisoning is based on 1999 data on incidence of blood lead elevations over 10 µg/dL in children under 6 reported by the New York City Department of Health and Mental Hygiene (2001) for New York City and New York Department of Health data (2000) for the rest of the state (See Appendix A). Grosse uses a ‘background’ level of 2 µg/dL for children in lead-safe housing. I assumed that for children testing over 10 µg/dL, the mean blood lead level was 14 µg/dL (see Appendix A). The benefits in terms of net present value of lifetime earnings per birth cohort (annual benefit) are based on reducing these 17,389 children’s blood lead levels by an average of 12 µg/dL to the ‘background’ level (2 µg/dL) at a benefit of $3720 per child per µg/dL (17,389 * $3720 * 12 = $776,256,773)
[4] According to 2000 US census data, there were 1,239,417 children 0-5 in New York state. To estimate the number of 5 year olds, I divided this figure by 5, then divided by 2 to get the number of boys and girls.
[5] Kemper et al. estimated treatment costs from a variety of published sources in 1996 dollars (See Appendix A). I have assumed all poisoned children received these treatments. However, it is important to note
that Markowitz et al. (1999) suggest that as few as 25% of lead-poisoned children receive proper follow-up care.
[6] According to the U.S. General Accounting Office (1999), “83% of children with BLL>+20 µg/dL are Medicaid enrollees.”.
[7] Because the number of children in the state with BLL over 25 was not available, I took the proportion of children with BLL over 10 whose levels are over 25 (based on Monroe County Department of Health database, 1996-2000) to be .073. Multiplying this proportion by the total number of children in NY with BLL over 10 (1,270) I derived the estimate of 254 children with BLL over 25 in the state in 1999.
[8] An earlier abstract of this work indicated that the population attributable risk values range from .11 to .38, depending on race and family income (Needleman 2000). Attributable risk is the additional incidence of delinquency that could be eliminated if lead exposure was eliminated.
[9]These figures are based on the 1998-99 requested budget of the Office of Child and Family Services for “youth facilities” of $123,436,000 (http://www.state.ny.us/dob/archive/989archive/989appd1/ocfs.pdf). However, using the figure of 4813 residential placements statewide (Sickmund and Wan, 2001) at a cost of $80,000 per juvenile per year (personal communications), would yield a total cost of $345,440,000 per year. Thus, the estimates in the table may be low by a factor of two or more. In addition, they do not include the costs of non-residential outcomes for juvenile delinquents.
[10] The costs used from Kemper et al. (1999, p. 1206) are as follows: Venipunture ($6.53), Lead assay ($17.42), Nurse-only visit ($32), Physician visit ($80), Environmental investigation and hazard removal ($335), Oral chelation ($235), Intravenous chelation ($1843). Note that an additional visit may not always be necessary, as the child may be visiting the physician’s office for other reasons. For consistency with the Kemper et al. model, however, the costs of each additional visit have been included here.