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This article continues the report of a study at the St Louis Comprehensive Neighborhood Health Center in which definitive blood lead levels were routinely determined in pediatric patients younger than 5 years of age. Data on changes during the 1980s in population, housing, and soil lead levels also are provided for possible correlation with changes in blood lead levels. From 1976 through 1993, there has been a progressive decline in annual mean blood lead levels and in the percentage of patients at several ranges indicative of different degrees of risk for brain damage. Comparisons of blood lead levels in residents of other neighborhoods in the city of St Louis show that most predominantly black neighborhoods and a single predominantly poor white neighborhood are particularly high-risk areas. In the study catchment area, the total population has decreased but the number of children younger than 5 years of age has increased. The latter has resulted in about a doubling of admissions to our health center in 1993. There also has been a decline in occupied housing units, an increase in unoccupied units (probably unfit for habitation), and the demolition of more than 6700 units. There also has been a remarkable citywide reduction in soil lead levels, somewhat more marked in the study catchment area than in some other areas of the city. The reduction in the lead burden in children in the study catchment area appears to be associated with the decline in housing units and the decline in soil lead levels.

This article presents data on total cholesterol (TC) determinations carried out in black patients of an inner-city neighborhood health center. In the pediatric group (under age 18), TC determinations were carried out only in over-weight children. In adults, they were performed routinely on all new admissions. During 1992, a total of 1158 TC determinations were made, 385 in males and 773 in females. Age-related changes in mean TC were compared between black males and females, between males in our population and those in the general population, and between females in the two populations. Age-related changes in the proportion of cases in our population also were analyzed in the desirable, borderline, and high-risk TC levels. Our objective was to determine if these data could account for the higher black mortality rates from coronary heart disease (CHD) than in the general population. The data show that mean TC levels and risk ratios are not substantially different in our population than in the general population. The differences in CHD mortality rates in the two populations, therefore, cannot be attributed to TC levels.

A sharply focused study is presented defining the demographic characteristics of the catchment area of a St Louis health center and determining the blood lead (PbB) levels in children from 1977 to 1989. The sources of lead exposure are examined, and the adequacy of erythroprotoporphyrin (EP) determinations are evaluated to identify children with toxic levels. Mean PbB levels and prevalence rates at higher ranges were not only substantially higher in the catchment area population than in white children, but also significantly higher than in black children nationally. Since 1980, mean PbB declined progressively in the catchment area children, but it was not until 1989 that the mean PbB had declined to the 1980 level in white children nationally. PbB parameters in the catchment area children were not only higher than in children in other St Louis neighborhoods, but also higher than in children living in towns adjacent to a lead smelting operation. The environmental sources of lead considered here do not appear to fully account for the higher PbB levels in the children in the catchment area. Nutritional factors also need to be considered. Furthermore, the EP lacks both sensitivity and specificity for identifying children with PbB levels greater than or equal to 25 micrograms/dL and greater than or equal to 15 micrograms/dL. While this study identifies a community that has experiences a high prevalence of lead toxicity in its children, it also suggests that nationwide and even citywide estimates of the prevalence of lead toxicity based on EP screening may be significantly lower than actual prevalences.