Perinatal & Pediatric
Firearm-related Lead Exposure and Child Lead Levels in the United States, 2012-2018. Christian Hoover* Christian Hoover Alan Fossa Megan L. Ranney Gabrielle G. Hoover Aaron J. Specht David Hemenway Joseph M. Braun
Firearm-related lead ammunition use is an unregulated source of lead exposure in the United States and could disproportionately impact children. For this cross-sectional ecological study, we investigated whether household firearm ownership rates (as proxy for firearm-related lead exposure) was associated with the prevalence of child blood lead levels equal or above 5 µg/dL in 44 US States between 2012 and 2018. To control for confounding factors, we adjusted for other known lead exposures (old housing stock, lead-related occupations, and lead water service lines), poverty rate, population density, White race, and calendar year. To address missing data, we used multiple imputation by chained equations. We ran a spearman’s correlation matrix and a series of negative binomial regressions. As expected, cases of child lead levels were positively correlated with firearm ownership, older housing, and lead water line services. Household firearm ownership levels were positively correlated with poverty, occupations with lead exposure, and race; they were negatively correlated with housing and population density. In fully adjusted models, one IQR higher state-level household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (Prevalence Rate Ratio: 1.41, 95% CI: 1.11-1.79). This study provides national-level evidence that household firearms may be an important source of childhood lead exposure. More research is needed to substantiate this relationship at the individual level as well as to prove causality of the relationship.