ORIGINAL CONTRIBUTIONS |
Relation between Blood Lead Levels and Childhood Anemia in India
1 VA Boston Healthcare System, West Roxbury, MA
2 Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
3 Exposure, Epidemiology and Risk Program, Departments of Environmental Health and Epidemiology, Harvard School of Public Health, Boston, MA
4 Department of Surgery, Divisions of General Surgery and Surgical Research, University of Basel, Basel, Switzerland
5 Department of Population Health Sciences, University of Wisconsin Medical School, Madison, WI
6 Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
Correspondence to Dr. Nitin Jain, Veterans Affairs Medical Center-Harvard Medical School (VAMC-HMS), Programs in Research, 1400 VFW Parkway, West Roxbury, MA 02132 (e-mail: Nitin_Jain{at}hms.harvard.edu).
Lead pollution is a substantial problem in developing countries such as India. The US Centers for Disease Control and Prevention has defined an elevated blood lead level in children as 
10 µg/dl, on the basis of neurologic toxicity. The US Environmental Protection Agency suggests a threshold lead level of 20–40 µg/dl for risk of childhood anemia, but there is little information relating lead levels <40 µg/dl to anemia. Therefore, the authors examined the association between lead levels as low as 10 µg/dl and anemia in Indian children under 3 years of age. Anemia was divided into categories of mild (hemoglobin level 10–10.9 g/dl), moderate (hemoglobin level 8–9.9 g/dl), and severe (hemoglobin level <8 g/dl). Lead levels <10 µg/dl were detected in 568 children (53%), whereas 413 (38%) had lead levels 10–19.9 µg/dl and 97 (9%) had levels 20 µg/dl. After adjustment for child's age, duration of breastfeeding, standard of living, parent's education, father's occupation, maternal anemia, and number of children in the immediate family, children with lead levels 10 µg/dl were 1.3 (95% confidence interval: 1.0, 1.7) times as likely to have moderate anemia as children with lead levels <10 µg/dl. Similarly, the odds ratio for severe anemia was 1.7 (95% confidence interval: 1.1, 2.6). Health agencies in India should note the association of elevated blood lead levels with anemia and make further efforts to curb lead pollution and childhood anemia.
anemia; child; India; lead; lead poisoning
Abbreviations: CI, confidence interval
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