Objective: Evaluate the effect of changes in the water disinfection process, and presence of lead service
lines (LSLs), on children's blood lead levels (BLLs) in Washington, DC.
Methods: Three cross-sectional analyses examined the relationship of LSL and changes in water
disinfectant with BLLs in children o6 years of age. The study population was derived from the DC
Childhood Lead Poisoning Prevention Program blood lead surveillance system of children who were
tested and whose blood lead test results were reported to the DC Health Department. The Washington, DC
Water and Sewer Authority (WASA) provided information on LSLs. The final study population consisted of
63,854 children with validated addresses.
Results: Controlling for age of housing, LSL was an independent risk factor for BLLs Z10 mg/dL, and
Z5 mg/dL even during time periods when water levels met the US Environmental Protection Agency (EPA)
action level of 15 parts per billion (ppb). When chloramine alone was used to disinfect water, the risk for
BLL in the highest quartile among children in homes with LSL was greater than when either chlorine or
chloramine with orthophosphate was used. For children tested after LSLs in their houses were replaced,
those with partially replaced LSL were 43 times as likely to have BLLs Z10 mg/dL versus children who
never had LSLs.
Conclusions: LSLs were a risk factor for elevated BLLs even when WASA met the EPA water action level.
Changes in water disinfection can enhance the effect of LSLs and increase lead exposure. Partially
replacing LSLs may not decrease the risk of elevated BLLs associated with LSL exposure.
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