In 2015, pediatrician Mona Hanna-Attisha, MD, based in Flint, Michigan, conducted research that found children in her community had been exposed to dangerous levels of lead from contaminated drinking water.
Hanna-Attisha dove into data from the local hospital’s Epic Electronic Health Record (EHR) to build her study. Using this data, she exposed Flint’s water crisis.
This research sparked the curiosity of a team of clinicians and data scientists: “Was it just a Flint problem or were there other areas of the United States that also had children with high blood lead? Said Doug Winesett, MD, in an interview with Fierce Healthcare.
Two teams of clinicians and data scientists analyzed Epic Systems anonymized health data on 5.6 million children born between 2014 and 2020 for a study. In addition to identifying the two regions with the most affected children, they also found that 16 of the top 20 problem areas were in urban settings, according to the Epic Health Research Network (EHRN) study.
Local providers are likely paying more attention to the prevalence of lead in their communities, Winesett, one of the study’s authors, told Fierce Healthcare. But the country as a whole may not see the big picture or realize how widespread the problem is. The study aimed to remedy this.
Although there are regional variations across the country, the Midwest and Northeast have the highest proportion of children with high levels of lead in their blood, according to the analysis.
The states with the most affected areas are Ohio, New York and Illinois, according to the study. The data used is not exhaustive, and in areas where the sample is less representative (defined as penetrance), the numbers may be overinflated, Winesett said.
RELATED: IHI 2018: How A Pediatrician Got At The Center Of Flint’s Water Crisis
The “silent” epidemic
The problem with lead exposure is that the symptoms aren’t really visible, Hanna-Attisha told Fierce Healthcare. It’s what she calls a “silent pediatric epidemic” and the reason why she decided to title her book on Flint’s water crisis as “What the Eyes Can’t See”.
Hanna-Attisha was not involved in the new EHRN analysis of blood lead levels in children.
Children under the age of six are at higher risk because they are still developing, and even low blood lead levels can permanently damage cognitive function. Thus, criteria exist for providers to screen children through blood tests. Guidelines may vary from state to state. Those most at risk of exposure, according to the Centers for Disease Control and Prevention (CDC), are children from low-income families, communities of color, and those living in homes built before 1978 (the year where the residential use of lead paint has been prohibited). For children with these and other risk factors, it is recommended that they be screened at least once at the age of one year.
To track lead exposure in the workplace among adults, the CDC runs a program called ABLES.
“Lead is a chronic form of environmental racism,” Hanna-Attisha said. Lead exposure doesn’t start and end with Flint, she stressed. While the United States has banned the residential use of lead paint, for example, older homes that contain it still exist; While the use of lead pipes for water consumption was also banned, not all of the old pipes were torn off.
“We have this legacy of lead that we haven’t dealt with yet,” the pediatrician said. “There are Flints everywhere.”
The power of data
Winesett and his teams looked at the anonymized health data available through Epic Systems’ Cosmos database, which is part of the EHRN and collects data from participating Epic customers. The database currently houses what the company calls “observational evidence” on 115 million patients across the country.
Due to the accessibility of the data, the study did not take long, unlike traditional research, Winesett explained. “We can do it in a much shorter time frame because we have access to this data,” he said.
RELATED: EHR Helps Hospital Identify Michigan Lead Problem
The CDC’s Children’s Blood Lead Monitoring System collects data from state and local health departments. This kind of bird’s eye view is “not a goal usually offered to clinicians,” Hanna-Attisha said. But after hearing about the potential contamination of Flint’s drinking water in 2015, that kind of data is what she needed to assess lead levels in children in her county. After encountering many obstacles in obtaining the state-level data, the pediatrician turned to her own hospital, Hurley Medical Center, which was using Epic. Ultimately, housing the only children’s hospital in its community, it had a lot of data – county-wide, in fact.
With this data, Hanna-Attisha was able to observe health trends over time and identify the Flint Water Switch as the culprit for the high levels of lead in the blood.
“Epic is one of the unsung heroes of Flint’s water crisis,” Hanna-Attisha said, noting that the system has come in handy when public health agencies have failed.
She added that electronic medical records can “complement surveillance systems” as a creative way to identify high-risk areas.
Pathways to follow
Despite its capabilities, Epic’s data is limited. All of the results are an underestimate of the ongoing preventable lead exposure across the country, Hanna-Attisha said. State and federal policies to address systemic inequalities in health are needed.
“We are literally using children as detectors for environmental contamination,” she said. The screening “tells me there is an environmental problem, but it is too late for this child.”
To combat lead poisoning, the CDC recommends primary and secondary prevention, elimination of environmental lead hazards, and follow-up care. In 2016, the state of Michigan obtained permission from the Centers for Medicare & Medicaid Services (CMS) to expand health coverage and lead reduction services for qualifying properties. Hanna-Attisha is a supporter of these types of programs.
While some may claim they are expensive, the pediatrician pointed to a report by the Pew and Robert Wood Johnson Foundation which found that preventing lead poisoning in children born in 2018 alone could save $ 84 billion. Americans over the long term (not counting the costs of achieving prevention).
There is no cure for lead poisoning, but there are support mechanisms that can help, such as ensuring good nutrition and access to health care. Hanna-Attisha, who is currently director of the Pediatric Public Health Initiative at Michigan State University and Hurley Children’s Hospital, also runs a community program called the Flint Registry. It also uses Epic to track residents over time, she said, and direct those affected by lead-contaminated water to resources.
Hanna-Attisha and Winesett see a lot of promise in population-level health data, which can reveal trends and crises that lead to action to improve public health.