Lead Poisoning Prevention Efforts in High-Risk Environments: Follow-up Testing Rates among Preschool Children in Flint, Michigan, 2013-2015

J Racial Ethn Health Disparities. 2021 Feb;8(1):199-209. doi: 10.1007/s40615-020-00772-0. Epub 2020 Jun 8.


Objectives: Despite the importance of screening in efforts to address lead poisoning, many children in the United States have never been tested for lead, even when required to receive blood lead testing by state and federal healthcare policy. Fewer children gain access to follow-up or confirmatory testing when elevated blood lead levels are detected.

Methods: In response to previous research that illustrates the extent to which follow-up treatment services have been underutilized and poorly coordinated, this retrospective cohort study examines follow-up testing trends for lead poisoning among Medicaid-enrolled children 6 years and younger in Flint, Michigan, between 2013 and 2015.

Results: These findings illustrate that compliance with follow-up testing procedures was less than adequate during the period of study.

Conclusion: As illustrated in this bivariate analysis, subpopulations in Flint most likely to have lead poisoning were least likely to receive follow-up testing. Evidence also demonstrates that the likelihood that children with lead poisoning received follow-up testing was overwhelmingly associated with their blood lead concentration level than other indicators including socioeconomic status in this high-risk environment.

Keywords: Flint water crisis; Flint, Michigan; Follow-up testing; High-risk; Lead poisoning; Medicaid-enrolled.

MeSH terms

  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Healthcare Disparities*
  • Humans
  • Lead / blood*
  • Lead Poisoning / diagnosis
  • Lead Poisoning / prevention & control*
  • Male
  • Mass Screening / statistics & numerical data*
  • Medicaid / statistics & numerical data
  • Michigan
  • Retrospective Studies
  • Risk Assessment
  • Social Class
  • United States


  • Lead