Child lead testing erratic in Wisconsin
Childhood lead testing in Wisconsin is inconsistent to the point that some counties with the greatest risk for lead poisoning are among those testing the least, a USA TODAY NETWORK-Wisconsin analysis found.
Though the national spotlight has focused on lead pipe hazards in the wake of the Flint, Mich., water crisis, lead paint causes nearly all childhood lead poisoning in Wisconsin, experts say. The key indicator there is whether a house was built before 1950, when the use of lead paint was most common.
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Clark and Iowa counties have some of the state's largest concentrations of pre-1950s homes, but both are in the bottom 10 for the percentage of children tested for lead poisoning, according to Wisconsin Department of Health Services and U.S. Census data.
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Lead poisoning is irreversible and can cause developmental delays and changes in behavior and health. A 2010 report estimated Wisconsin would save $28 billion in cost and earnings if lead poisoning were completely eliminated, saving on medical treatment, special education, crime and government services, while increasing high school graduation rates and lifetime earnings.
Nearly 4,000 Wisconsin children younger than age 6 — 4.5 percent of those tested — were positive for lead poisoning in 2014, meaning they exceeded the U.S. Centers for Disease Control and Prevention threshold of 5 micrograms of lead per deciliter of blood. About 20 percent of all children younger than 6 were tested, but testing rates for individual health departments ranged from less than 10 percent to more than 40 percent.
The variation comes from local factors like age of housing and reliance on doctors for lead testing, officials say. Local health departments do lead testing for those without private insurance, but doctors are otherwise tasked with screening children for lead poisoning risk factors — such as regular contact with a pre-1950 house or a sibling with lead poisoning — and conducting a blood test if warranted.
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There are state guidelines for when to conduct in-home investigations of positive tests, but there is no statewide mandate on which children should be tested.
Calumet County was a distant last in the number of children tested in 2014 at about 5 percent. Linda Schwobe, public health nursing supervisor, said there’s only so much the county can do to boost those numbers.
“The physician does make the choice,” said Schwobe, who noted the county has talked to local doctors to encourage lead testing. “There’s recommendations out there from the lead program stating we recommend all 1 and 2-year-olds be tested.”
It’s difficult to say whether providers should be blamed when tests are infrequent, since officials don’t track the number of children who go through the screening questions, said Mary Dorn, health officer for Outagamie County.
Outagamie is among the least frequent testers at 11 percent of children younger than 6, but it is also well below the state average for the prevalence of pre-1950 homes.
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Lead testing rates are low even among the Wisconsin populations required to be tested — children on Medicaid or in the state’s Women, Infants and Children program. Those low-income families are far more likely to be renting the older, poorly maintained homes that are frequent sources of lead contamination, officials say.
Only 47 percent of the state’s 90,000 Medicaid-eligible children younger than 6 were tested in 2014, according to a state lead report. That comes despite the high correlation between those groups and lead poisoning. Medicaid-enrolled children were just less than half of all children tested for lead, but they comprised 88 percent of the children found to be lead poisoned.
Legislator questions policies
One Wisconsin legislator thinks health officials should be doing more to address the problem.
“There’s no one who can dispute our standards are dangerously out of date and the testing that needs to be done to identify the source isn’t being done by the state,” said state Rep. Chris Taylor, D-Madison.
Current state law allows DHS to request admission to a home for a lead investigation if a child registers a lead level of 10 micrograms per deciliter. It requires in-home testing for one test at 20 or two at 15. The investigations, conducted by local health officials, don’t include water tests, though they often include educating families in older homes on prevention measures such as running the water for several minutes before use and not using hot water for drinking.
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Taylor co-sponsored a bill that would have mandated in-home investigations for all lead tests above the CDC threshold of 5 units and required water testing in all cases. That would increase the number of lead poisoning investigations statewide from about 500 per year to 5,000 or more per year, according to DHS statistics.
The bill was introduced late in the session and didn’t go anywhere, but Taylor said she has been approached by several Republicans about working together and plans to re-introduce the bill next session.
Health officials say water is not typically tested because preliminary investigation can reveal it to be an unlikely cause, such as when only one child in a home has lead poisoning. Paint chips snatched from windowsills are a more typical cause of lead poisoning.
Taylor’s bill would have provided $500,000 in additional funding through DHS to help local health departments with the cost of additional investigations. Resources have been strained in Wisconsin since 2012, when a lower CDC threshold increased the pool of children identified as at risk nearly tenfold. The change did not come with an accompanying boost in funding for local or state health officials.
“We just moved nursing time to lead poisoning from other things that weren’t necessarily required services of the department,” said Amy Wergin, Manitowoc County health officer.
Lead-based paint is a particular problem in Wisconsin because it has more old homes than most states, ranking 12th in the nation for the number of homes built before 1950.
Lead paint hazards were identified as the cause of lead poisoning in 77 percent of DHS investigations from 2010 to present, according to state Department of Human Services spokeswoman Jennifer Miller. Ninety percent of Wisconsin children who tested positive for lead poisoning in 2014 lived in a house built before 1950.
“I think we’ve also done a pretty good job of targeting our testing to children who are high risk,” said Margie Coons, manager of the Wisconsin Childhood Lead Poisoning Prevention Program in the state Department of Health Services. “While it might be best that all children be tested, it’s more important to focus on the children at high risk.”
A number of states require lead testing for all children, including Delaware, Iowa, Maryland, Massachusetts, New Jersey.
State improving, but trouble spots remain
The percentage of children testing positive for lead poisoning has steadily fallen in Wisconsin, as communities take a proactive approach to addressing lead paint.
“Once lead poisoning occurs, the damage is permanent to the brain, so primary prevention is always our priority … rather than being reactionary,” Coons said.
Milwaukee — which has the state’s highest concentration of high-risk homes — has used federal grants to do lead abatement at 17,000 properties over the last 15 years to seal up or remove lead paint and other contaminated surfaces. The last grant focused on six zip codes that had the highest concentrations of lead poisoning.
The percentage of Milwaukee children testing over 10 micrograms per deciliter — the CDC standard up to 2012 — fell from 32 percent in the late 1990s to 2.7 percent in 2014.
“There’s been a remarkable decline by focusing on primary prevention before kids get poisoned, focusing on windows as a primary source of dust and fine particulates, and also recommending blood testing in a very aggressive way, working with parents and health care providers,” said Paul Biedrzycki director of disease control and environmental health for the city of Milwaukee.
Milwaukee had the state’s highest testing rate in 2014 at 44 percent of children younger than 6. However, the city still posted the highest percentage of children testing positive for lead poisoning that year, with 8.6 percent exceeding the new CDC standard in 2014.
Watertown was second-highest at 8.4 percent, followed by Buffalo County at 7.3 percent and Sheboygan County at 6.3 percent. With 34 percent of its homes built before 1950, Sheboygan is among the 15 counties with the oldest homes.
The lead poisoning there is most commonly due to paint chips, but it can also stem from cultural practices, such as cooking or serving with Mexican pottery or using traditional Hmong remedies, both of which can contain lead, officials said. Lead pipes haven’t been to blame for any recent lead poisoning, said Diane Liebenthal, the program supervisor for the county’s health department.
Sheboygan also tests a relatively low number of children, particularly given the frequency of positive test results. The county tested 14 percent of those younger than 6 in 2014, well below the state average of 20 percent.
The low rate came as a surprise to health officials, as Liebenthal earlier in the interview had noted the county is “really proud of the number of kids that have been tested.”
De Pere, in Brown County, has one of the lowest rates of lead poisoning even as it monitors the situation more closely than most local health departments, testing 25 percent of those younger than 6 in 2014. Chrystal Woller, city health officer, attributed the success to having few old buildings, maintaining those they do have, and working closely with pediatricians.
Eric Litke is an investigative reporter for USA TODAY NETWORK-Wisconsin. Reach him at 920-453-5119, elitke@gannett.com or on Twitter@ericlitke.