摘要：Objectives. We described elevated blood lead level (BLL; ≥ 10 μg/dL) prevalence among newly arrived refugee children in Massachusetts. We also investigated the incidence of BLL increases and BLLs newly elevated to 20 μg/dL or higher in the year following initial testing, along with associated factors. Methods. We merged data from the Massachusetts Department of Public Health's Refugee and Immigrant Health Program and the Childhood Lead Poisoning Prevention Program on 1148 refugee children younger than 7 years who arrived in Massachusetts from 2000 to 2007. Results. Elevated BLL prevalence was 16% among newly arrived refugee children. The rate ratio for BLL elevation to 20 μg/dL or higher after arrival was 12.3 (95% confidence interval [CI] = 6.2, 24.5) compared with children in communities the state defines as high-risk for childhood lead exposure. Residence in a census tract with older housing (median year built before 1950) was associated with a higher rate of BLL increases after resettlement (hazard ratio = 1.7; 95% CI = 1.2, 2.3). Conclusions. Refugee children are at high risk of lead exposure before and after resettlement in Massachusetts. A national surveillance system of refugee children's BLLs following resettlement would allow more in-depth analysis. Refugee children who resettle in the United States may arrive with substantially higher blood lead levels (BLLs) than those among children in the general US population. 1 , 2 For recently arrived refugees, the risk of additional lead exposure after immigration may also be substantial. In 2000, a 2-year-old Sudanese refugee child died as a result of exposure to lead in her family's New Hampshire home. 3 A subsequent case series among children resettled in New Hampshire raised concerns that African refugee children may be at particularly high risk of lead exposure. In that study, 22 of 71 children (31%) who arrived without an elevated BLL (≥ 10 μg/dL) had an elevated BLL at follow-up testing, indicating new exposure to lead after immigration. 2 Preventing postimmigration lead exposure among refugee children is an important public health priority because of the irreversible behavioral and cognitive deficits caused by even low levels of lead exposure in early childhood. 4 Families may be placed in housing with inherently high health risks—generally older, nonrehabilitated housing with lead exposure hazards from deteriorating paint or contaminated soil. Such families may also have difficulty accessing health care over time, so cases of lead poisoning may not be identified. To prevent lead exposure and its adverse consequences in refugee children, information regarding the sources of lead, its prevalence, and the severity of exposure is necessary. Our primary goal was to describe the risk of elevated BLLs among refugee children upon arrival in the United States and in the period following resettlement. Secondary goals were to determine whether African origin was associated with an increased risk of elevated BLL at initial and follow-up testing and whether residence in housing built prior to 1950 (after which use of lead in residential paint declined) was associated with postimmigration increases in BLL.
