Firearm-Related Lead Exposure and Child Lead Levels in the United States, 2012-2018.

Objective: To determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead.
Study Design: For this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations.
Results: Prevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each IQR (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79).
Conclusion: These data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level.
Competing Interests: Declaration of Competing Interest JMB has been compensated for serving as an expert witness for plaintiffs involved in PFAS-contaminated drinking water and has NIH funding: R21 ES034187. MR has grants from the CDC and NIH related to firearm injury, and has unpaid roles as Senior Strategic Advisor to AFFIRM at the Aspen Institute and as a Board Member for the NonViolence Institute. The other authors have no conflicts of interest to disclose.
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