100 - Epidemiologic Trends in Pediatric Lead Poisoning for Children with Autism Spectrum Disorders at Freestanding Children’s Hospitals, 2016-2023

Publication Number: 1092.100

Diane Story, Boston Children's Hospital, Boston, MA, United States; Phillip D.. Hahn, Boston Children's Hospital, Boston, MA, United States; Carly E.. Milliren, Boston Children's Hospital, Boston, MA, United States; Dionne Graham, Boston Children's Hospital, Boston, MA, United States; Corinna J. Rea, Boston Children's Hospital, Medfield, MA, United States; Carol Weitzman, Boston Children's Hospital, Boston, MA, United States; Marissa Hauptman, Boston Children's Hospital, Boston, MA, United States

Background: Given the intersection of autism spectrum disorders(ASD) and pica behaviors, children with ASD are at increased risk of elevated blood lead levels, but little is known about the prevalence and management of severe lead poisoning in this population.

Objective: This study aims to characterize the burden of severe lead poisoning in children with a diagnosis of ASD across freestanding children's hospitals in the United States.

Design/Methods: This retrospective cohort study used data from the 47 hospitals in the Pediatric Hospital Information System from 2016-2023, and included encounters for patients with a primary diagnosis of lead poisoning who were ≤18 years of age at admission. Comorbid diagnosis categories were derived from ICD-10 diagnosis codes in non-primary positions. Wilcoxon tests, Fisher's exact tests and Pearson's chi-squared tests were applied to investigate differences between patients with and without ASD. Poisson, linear, and logistic regression models were calculated to investigate clinical characteristics by ASD status, controlling for age, sex, and inpatient status.

Results: Of the 1,982 encounters in this cohort, 159 were for those with ASD (8.0%). 139 encounters (87.4%) for patients with ASD were inpatient, compared to 706 encounters for those without ASD (38.7%, p<.001). The average age at discharge of those with ASD was 4.94 years (SD: 2.94), while the average age of those without ASD was 2.72 years (SD: 2.55, p<.001). 47.2% of those with ASD had a comorbid diagnosis of pica, compared to 7.2% of those without ASD (p <.001). Of those with an inpatient stay, those with ASD had a longer mean length of stay (5.03 days, SD: 6.27) than those without ASD (mean 3.73 days, SD: 3.30, p=.018). 74.8% of patients with ASD were administered chelation, compared to 30.5% of patients without autism (p <.001). Children with ASD also had 3.2 times the odds of IV chelation as those without ASD (p <.001). On average, after controlling for age, sex, and encounter type, encounters for children with ASD had billed charges that were $12,892.20 greater than those without ASD (p <.001).

Conclusion(s): Overall, patients with ASD had lead poisoning encounters at later ages than those without ASD, and greater severity according to length of stay and chelation administration. Patients with ASD were also 6.6 times more likely to have a diagnosis of pica than those without ASD. More recognition of lead poisoning risk in children with neurodevelopmental disabilities is needed to protect children beyond the typical testing windows, and to ensure that housing policies are adequately protective.

Comorbidities for children by ASD diagnosis for children with lead poisoning
Children with ASD were statistically more likely to have diagnoses of anemia, pica, constipation, expressive language delay, failure to thrive and psychological development comorbidities compared to children without ASD. (N = 1,982, N with ASD = 159, N without ASD = 1,823)

Chelation administration by ASD diagnosis for children with lead poisoning
Children with ASD were statistically more likely to be prescribed oral chelation therapy with succimer (DMSA) as well as parenteral chelation therapy with edetate calcium disodium. (N = 1,982, N with ASD = 159, N without ASD = 1,823)