294 - Associations of the Child Opportunity Index and 311-Reported Tenant Housing Complaints with Elevated Blood Lead Levels in Children

Publication Number: 2284.294

Joseph Wilson, Harvard T.H. Chan School of Public Health, Cambridge, MA, United States; Diane Story, Boston Children's Hospital, Boston, MA, United States; Natalie Slopen, Harvard T. H. Chan School of Public Health, Boston, MA, United States; Gary Adamkiewicz, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Marissa Hauptman, Boston Children's Hospital, Boston, MA, United States

Background: Housing age is the strongest predictor of lead exposure in the U.S., but neighborhood conditions may modify risk. Indices specifically focusing on children such as the Child Opportunity Index (COI) may better capture the pediatric built environment than individual predictors, and publicly available data such as 311-tenant-reported housing problems can serve as a proxy for built-environment burden.

Objective: To assess whether the COI level and 311 tenant-reported housing complaint burden are associated with elevated blood lead levels (BLLs) at the individual and neighborhood (census block-group) level.

Design/Methods: We conducted a retrospective study of 6,216 Boston Children's Hospital primary-care patients with venous BLL testing from January 1, 2018-December 31, 2024. Residential addresses were geocoded and linked to census block-group COI level and to quartiles of 311-reported tenant housing-complaint incidence between 2018-2024. Individual outcome was at least one elevated BLL test, and the block-group outcome was the number of children with an elevated BLL, offset by number of children tested. We used logistic regression with cluster-robust standard errors (clustered by block group) for individual models and negative binomial regression for block-group positivity rates. Individual-level models were adjusted for age, sex, race and ethnicity, and block-group pre-1950 housing percentage (quartiles). Block-group models were adjusted for pre-1950 housing percentage (quartiles). Because the outcome prevalence was ~2%, odds ratios approximate relative risks.

Results: Higher 311 complaint burden was associated with greater lead risk. At the individual level, children in higher-complaint burden areas (quartile 3) had higher odds of an elevated BLL (RR≈2.35, 95% CI 1.16-5.29); at the block-group level, higher complaint burden was associated with higher positivity rates (IRR≈2.37, 95% CI 1.09-5.63). COI level was not significantly associated with the outcomes, likely reflecting limited heterogeneity (94% of study patients resided in low or very low opportunity areas).

Conclusion(s): 311-reported tenant-housing complaints identify neighborhoods with higher pediatric lead burden. Integrating 311 data with housing-age indicators can help inform proactive screening and place-based interventions. Further work with more heterogeneous samples is needed to parse out the impact of neighborhood opportunities.

Spatial distribution of COI level and 311-reported tenant housing complaints
A) Metro Child Opportunity Index (COI) Level. Choropleth maps show the quintiles of the COI. Block groups are compared within the Boston-Cambridge-Newton, MA metropolitan statistical area. B) Quartiles of 311-reported housing complaints incidence rates in Boston, MA, 2017-2024. Choropleth maps show the quartiles of 311-reported housing complaints across the study population. Quartiles derived from the citywide distribution of 311 reports. Block groups with less than 10 children or less than 5 residential units are not included in the study and are included in the 'no data' category.

Individual-level univariate and multivariate associations of COI and 311-reported tenant housing complaints and the outcome of having an elevated BLL.
Predictors shown reflect neighborhood-level factors. Dots indicate relative risk (approximated from the odds ratio). Horizontal lines indicate 95% confidence intervals (CI).

Block group-level univariate and multivariate associations of COI and 311-reported tenant housing complaints and the outcome of having an elevated BLL.
Dots indicate relative risk (approximated from the odds ratio). Horizontal lines indicate 95% confidence intervals (CI).