Childhood Blood Level Analysis Using Full SAMPADA Data - Pb Continuous

Author

ICMR

Part 1. Bivariate analysis of blood lead levels

A. Demographic

Descriptive (Mean/SD)
Univariate Linear Regression
Characteristic N = 4,306 N Mean Difference (β) 95% CI p-value
PSU Rural/Urban 4,306
Rural 4.7 (3.9)
Urban 4.9 (3.9) 0.24 -0.01, 0.49 0.063
Gender 4,306
Female 4.6 (3.8)
Male 4.9 (4.0) 0.34 0.10, 0.57 0.005
age_gp 4,306
1-2 5.2 (4.5)
2-3 4.6 (3.5) -0.60 -0.99, -0.21 0.002
3-4 4.8 (4.1) -0.38 -0.76, -0.01 0.047
4-5 4.6 (3.8) -0.53 -0.90, -0.16 0.005
Caste 4,288
Other Caste 4.3 (3.3)
SC 4.9 (3.8) 0.60 0.24, 0.95 0.001
ST 4.0 (3.4) -0.22 -0.59, 0.15 0.2
OBC 5.3 (4.5) 1.1 0.74, 1.4 <0.001
Not known 4.2 (2.6) -0.03 -1.1, 1.0 >0.9
Religion 4,287
Hindu 5.1 (4.1)
Muslim 4.1 (3.5) -0.93 -1.4, -0.51 <0.001
Christian 3.6 (2.4) -1.5 -1.9, -1.1 <0.001
Others 3.1 (2.3) -2.0 -2.5, -1.4 <0.001
Abbreviation: CI = Confidence Interval
1 Blood Pb Levels (μg/dL): Mean (SD)

B. Household Characteristics

Descriptive (Mean/SD)
Univariate Linear Regression
Characteristic N = 4,306 N Mean Difference (β) 95% CI p-value
Type of Family 4,288
Extended 4.5 (3.5)
Joint 4.7 (4.1) 0.28 -0.13, 0.70 0.2
Nuclear 4.8 (3.9) 0.33 -0.03, 0.69 0.073
Ownership of house 4,272
Own House 4.7 (4.0)
Rented/Other 4.7 (3.2) -0.07 -0.43, 0.29 0.7
Type of House 4,286
Pucca 4.7 (3.9)
Semi-pucca 4.8 (3.8) 0.11 -0.16, 0.39 0.4
Kutcha 5.0 (4.4) 0.32 -0.03, 0.67 0.074
No of rooms in house 4,276
>1 4.6 (3.9)
0-1 5.5 (3.9) 0.87 0.49, 1.3 <0.001
Separate Kitchen 4,284
Yes 4.6 (3.8)
No 5.0 (4.2) 0.43 0.17, 0.69 0.001
Cooking fuel 4,306
Firewood 4.8 (4.1)
LPG 4.7 (3.8) -0.15 -0.40, 0.10 0.2
Others 6.1 (5.0) 1.3 0.47, 2.2 0.003
Drinking Water 4,285
Bore well 4.8 (4.4)
Open well 4.3 (3.6) -0.56 -1.1, -0.05 0.032
Others 5.2 (4.7) 0.42 -0.17, 1.0 0.2
RO/Bottled/Purchased water 5.1 (3.7) 0.32 -0.10, 0.73 0.13
Surface/Spring water 4.3 (2.8) -0.47 -1.1, 0.15 0.13
Tap water 4.6 (3.7) -0.21 -0.50, 0.08 0.15
Water tanker 5.4 (4.0) 0.58 -0.17, 1.3 0.13
Cooking water 4,284
Bore well 4.8 (4.4)
Open well 4.3 (3.6) -0.51 -1.0, 0.00 0.051
Others 5.2 (5.0) 0.41 -0.17, 0.99 0.2
RO/Bottled/Purchased water 4.9 (3.3) 0.08 -0.42, 0.58 0.8
Surface/Spring water 4.4 (2.9) -0.40 -1.0, 0.22 0.2
Tap water 4.7 (3.7) -0.14 -0.42, 0.15 0.3
Water tanker 5.5 (4.0) 0.66 -0.08, 1.4 0.080
Water purification method 4,287
Water filter/ E. Purifier 3.9 (3.6)
Boiling 3.9 (2.8) -0.04 -0.57, 0.49 0.9
Strain through a cloth 4.9 (3.6) 0.99 0.37, 1.6 0.002
Add bleach/chlorine tablets 6.0 (4.3) 2.1 0.78, 3.3 0.002
None 5.1 (4.3) 1.2 0.71, 1.7 <0.001
Others/Multiple 4.1 (3.0) 0.11 -0.47, 0.70 0.7
Latrine type 4,306
Present and using 4.7 (3.8)
Others 4.0 (2.8) -0.71 -1.3, -0.17 0.011
Open Defecation 5.8 (4.8) 1.1 0.74, 1.5 <0.001
Abbreviation: CI = Confidence Interval
1 Blood Pb Levels (μg/dL): Mean (SD)

C. Household Assets

Descriptive (Mean/SD)
Univariate Linear Regression
Characteristic N = 4,306 N Mean Difference (β) 95% CI p-value
Electricity Available 4,285
No 4.2 (2.9)
Yes 4.7 (3.9) 0.53 -1.1, 2.2 0.5
Electric Fan 4,290
No 4.4 (4.0)
Yes 4.8 (3.9) 0.41 0.03, 0.79 0.034
Black and White Television 4,290
No 4.7 (3.9)
Yes 5.2 (4.1) 0.46 -0.01, 0.94 0.056
Colour Television 4,290
No 5.0 (4.6)
Yes 4.6 (3.6) -0.46 -0.71, -0.21 <0.001
Radio/Transistor 4,290
No 4.8 (4.0)
Yes 3.9 (2.7) -0.86 -1.3, -0.40 <0.001
Pressure Cooker 4,290
No 5.5 (4.8)
Yes 4.5 (3.6) -1.0 -1.3, -0.73 <0.001
Cot/Bed 4,290
No 5.4 (4.2)
Yes 4.6 (3.9) -0.72 -1.1, -0.38 <0.001
Mattress 4,290
No 5.7 (4.7)
Yes 4.4 (3.6) -1.3 -1.5, -1.0 <0.001
Chair 4,290
No 5.4 (4.1)
Yes 4.7 (3.9) -0.69 -1.1, -0.30 <0.001
Table 4,290
No 5.3 (4.3)
Yes 4.5 (3.7) -0.85 -1.1, -0.60 <0.001
Mobile Phone 4,290
No 5.1 (3.9)
Yes 4.7 (3.9) -0.39 -0.92, 0.14 0.2
Landline Phone 4,290
No 4.7 (3.9)
Yes 4.3 (3.1) -0.44 -1.2, 0.31 0.3
Watch/Clock 4,253
No 4.9 (4.1)
Yes 4.7 (3.9) -0.21 -0.46, 0.05 0.11
Washing Machine 4,290
No 4.8 (4.0)
Yes 4.4 (3.8) -0.40 -0.67, -0.13 0.003
Refrigerator 4,290
No 5.0 (4.1)
Yes 4.5 (3.7) -0.48 -0.71, -0.25 <0.001
Computer 4,290
No 4.8 (3.9)
Yes 4.2 (3.3) -0.54 -1.1, -0.02 0.041
Internet 4,290
No 4.9 (4.1)
Yes 4.6 (3.7) -0.39 -0.63, -0.16 0.001
Sewing Machine 4,290
No 4.7 (3.9)
Yes 4.7 (3.8) -0.06 -0.38, 0.26 0.7
Air Conditioner/Cooler 4,290
No 4.7 (3.9)
Yes 4.9 (4.1) 0.20 -0.11, 0.51 0.2
Bicycle 4,290
No 4.7 (3.7)
Yes 4.8 (4.2) 0.05 -0.20, 0.29 0.7
Motorcycle/Scooter 4,290
No 4.7 (4.1)
Yes 4.8 (3.8) 0.13 -0.11, 0.36 0.3
Car/Four Wheeler 4,290
No 4.8 (4.0)
Yes 3.9 (3.3) -0.98 -1.3, -0.61 <0.001
Animal Drawn Cart 4,290
No 4.8 (4.0)
Yes 4.2 (3.2) -0.55 -1.1, -0.02 0.043
Water Pump 4,290
No 4.7 (3.9)
Yes 4.7 (4.3) 0.01 -0.33, 0.35 >0.9
Tractor 4,290
No 4.7 (3.9)
Yes 5.0 (4.2) 0.29 -0.37, 0.96 0.4
Thresher/Seed Removal Machine 4,290
No 4.7 (3.9)
Yes 4.9 (4.5) 0.12 -0.96, 1.2 0.8
Home Theatre 4,290
No 4.7 (3.9)
Yes 4.6 (2.9) -0.16 -0.92, 0.61 0.7
Vacuum Cleaner 4,290
No 4.8 (3.9)
Yes 3.5 (2.5) -1.2 -2.1, -0.37 0.005
Microwave/Electric Oven 4,290
No 4.8 (3.9)
Yes 3.4 (3.4) -1.4 -2.1, -0.61 <0.001
Treadmill/Exercise Equipment 4,290
No 4.7 (3.9)
Yes 5.1 (2.3) 0.38 -1.6, 2.4 0.7
Type of PDS/Ration Card 4,282
APL 4.5 (4.0)
No card 4.8 (3.8) 0.31 -0.05, 0.68 0.095
BPL/AAY/TPDS 4.8 (3.9) 0.32 0.03, 0.62 0.032
Any Woman Enrolled in a Self-Help Group 4,267
No 4.7 (3.9)
Yes 4.9 (4.0) 0.17 -0.09, 0.42 0.2
Any Household Member with Disability 4,279
No 4.7 (3.8)
Yes 4.9 (4.4) 0.19 -0.08, 0.47 0.2
Household Covered by Insurance 4,283
No 4.9 (3.9)
Yes 4.6 (4.0) -0.25 -0.49, -0.02 0.037
Household Owns Agricultural Land 4,192
No 4.6 (3.8)
Yes 5.0 (4.2) 0.46 0.20, 0.72 <0.001
Owns Livestock 4,130
No 4.7 (3.7)
Yes 4.9 (4.5) 0.28 0.00, 0.55 0.048
Cows/Bulls/Buffaloes/Yaks 936
No 5.1 (5.1)
Yes 5.0 (4.4) -0.16 -0.92, 0.61 0.7
Camels 692
No 4.8 (4.4)
Yes 4.7 (1.9) -0.08 -4.4, 4.3 >0.9
Horses/Donkeys/Mules 687
No 4.8 (4.4)
Yes 5.4 (2.3) 0.62 -4.4, 5.6 0.8
Goats/Sheep 798
No 4.6 (4.0)
Yes 5.2 (4.9) 0.62 0.00, 1.2 0.048
Pigs 700
No 4.9 (4.4)
Yes 4.4 (5.2) -0.49 -1.7, 0.71 0.4
Chickens/Ducks 788
No 5.0 (4.3)
Yes 4.6 (4.7) -0.44 -1.1, 0.20 0.2
Wealth Index 4,290
Highest 4.3 (3.7)
Higher 4.6 (3.8) 0.32 -0.06, 0.69 0.10
Middle 4.4 (3.2) 0.09 -0.28, 0.47 0.6
Lower 4.6 (3.7) 0.29 -0.08, 0.66 0.13
Lowest 5.7 (4.9) 1.4 1.0, 1.7 <0.001
Abbreviation: CI = Confidence Interval
1 Blood Pb Levels (μg/dL): Mean (SD)

D. Blood micro-nutrient levels

Descriptive (Mean/SD)
Univariate Linear Regression
Characteristic N = 4,306 N Mean Difference (β) 95% CI p-value
Anemia status 4,306
No Anemia 4.5 (3.7)
Any Anemia 5.1 (4.2) 0.54 0.30, 0.79 <0.001
Anaemia Status (Any, New) 4,306
No Anemia 4.5 (3.7)
Mild Anemia 4.9 (4.2) 0.39 0.09, 0.69 0.011
Moder+Sev Anemia 5.3 (4.2) 0.73 0.41, 1.1 <0.001
iron_def_adj 881
No Iron Deficiency 4.2 (3.5)
Iron Deficiency 4.8 (3.7) 0.58 0.10, 1.1 0.018
Anaemia Adjusted for Iron 912
No Anemia + Iron Deficiency 3.6 (2.1)
Anemia + No Iron Deficiency 4.4 (3.3) 0.86 -0.32, 2.0 0.2
No Anemia + No Iron Deficiency 4.7 (4.0) 1.1 -0.04, 2.2 0.059
Anemia + Iron Deficiency 5.1 (3.4) 1.5 -0.09, 3.1 0.065
Vitamin B12 Status 875
Normal (≥203 pg/mL) 4.5 (3.6)
Deficient (<203 pg/mL) 4.6 (3.9) 0.07 -0.44, 0.58 0.8
Serum Folate Status 874
Normal (≥4 ng/mL) 4.6 (3.7)
Deficient (<4 ng/mL) 4.4 (3.7) -0.24 -0.96, 0.48 0.5
Vitamin D Status 871
Normal (≥12 ng/mL) 4.5 (3.4)
Deficient (<12 ng/mL) 4.9 (4.8) 0.33 -0.32, 0.98 0.3
Abbreviation: CI = Confidence Interval
1 Blood Pb Levels (μg/dL): Mean (SD)

E. Inflammation

Descriptive (Mean/SD)
Univariate Linear Regression
Characteristic N = 4,306 N Mean Difference (β) 95% CI p-value
CRP Status 923
Inflammation 3.8 (2.7)
No Inflammation 4.6 (3.7) 0.88 -0.03, 1.8 0.058
AGP Status 921
Inflammation 4.2 (2.8)
No Inflammation 4.6 (3.8) 0.46 -0.25, 1.2 0.2
Inflammation Status 922
Inflammation 4.0 (2.7)
No Inflammation 4.7 (3.8) 0.73 0.08, 1.4 0.028
Abbreviation: CI = Confidence Interval
1 Blood Pb Levels (μg/dL): Mean (SD)

F. Anthropometry

Descriptive (Mean/SD)
Univariate Linear Regression
Characteristic N = 4,306 N Mean Difference (β) 95% CI p-value
Stunting status 3,526
No Stunting 4.6 (3.7)
Stunting 5.0 (4.1) 0.46 0.13, 0.80 0.006
Severe Stunting 5.7 (4.8) 1.2 0.74, 1.6 <0.001
Wasting status 3,493
No Wasting 4.7 (3.9)
Wasting 5.0 (4.4) 0.29 -0.13, 0.70 0.2
Severe Wasting 4.9 (3.4) 0.16 -0.64, 0.95 0.7
Underweight status 3,552
No Underweight 4.6 (3.7)
Underweight 5.3 (4.4) 0.71 0.38, 1.0 <0.001
Severe Underweight 5.4 (4.2) 0.81 0.30, 1.3 0.002
MUAC Group 3,559
Normal 4.8 (3.9)
severewasting 5.0 (3.0) 0.26 -0.57, 1.1 0.5
Abbreviation: CI = Confidence Interval
1 Blood Pb Levels (μg/dL): Mean (SD)

G. Dietary nutrient intake

Variable Beta 95% CI Lower 95% CI Upper P_Value
Energy Intake (kcal/day) -0.003 -0.005 -0.001 0.0126
Protein Intake (g/day) -0.132 -0.196 -0.068 0.0001
Carbohydrate Intake (g/day) -0.010 -0.022 0.002 0.1025
Total Fat Intake (g/day) -0.095 -0.164 -0.026 0.0070
Iron Intake (mg/day) -0.313 -0.523 -0.103 0.0035
Zinc Intake (mg/day) -0.493 -0.829 -0.156 0.0041
Calcium Intake (mg/day) -0.012 -0.017 -0.006 0.0000
Thiamine (B1) Intake (mg/day) -3.274 -5.581 -0.967 0.0054
Riboflavin (B2) Intake (mg/day) -7.723 -11.557 -3.890 0.0001
Niacin (B3) Intake (mg/day) -0.438 -0.746 -0.130 0.0053
Total Folate (B9) Intake (ug/day) -0.045 -0.063 -0.027 0.0000
Vitamin C Intake (mg/day) -0.057 -0.099 -0.016 0.0072
Vitamin A Intake (ug/day) -0.013 -0.021 -0.004 0.0027
Vitamin B12 Intake (ug/day) -0.479 -2.170 1.211 0.5782
Birth Weight (grams) 0.003 -0.005 0.010 0.4864

H. CBC parameters

Variable Beta 95% CI Lower 95% CI Upper P_Value
WBC Count 0.749 0.436 1.063 0.0000
Lymphocytes (%) 0.107 0.009 0.205 0.0330
Monocytes (%) -0.380 -0.746 -0.014 0.0421
Granulocytes (%) -0.075 -0.171 0.020 0.1229
Lymphocytes (Absolute Count) 1.753 1.170 2.336 0.0000
Monocytes (Absolute Count) 0.843 -1.122 2.809 0.4003
Granulocytes (Absolute Count) 0.550 0.030 1.070 0.0380
Red Blood Cell Count 7.231 5.244 9.217 0.0000
Hemoglobin -1.978 -2.700 -1.256 0.0000
Hematocrit -0.450 -0.712 -0.187 0.0008
Mean Corpuscular Volume -0.585 -0.703 -0.467 0.0000
Red Cell Distribution Width (CV) 2.255 1.690 2.821 0.0000
Platelet Count 0.044 0.034 0.054 0.0000

Part 2. Adjusted Linear Regression

The below analysis are adjusted for age, gender, type of house, urban/rural and wealth index

A. Drinking water source

Characteristic N Adj. β (95% CI)1 95% CI p-value
Drinking Water 4,283


    Bore well

    Open well
-0.39 -0.91, 0.12 0.13
    Others
0.36 -0.23, 0.95 0.2
    RO/Bottled/Purchased water
0.55 0.12, 0.98 0.012
    Surface/Spring water
-0.52 -1.1, 0.10 0.10
    Tap water
-0.11 -0.40, 0.19 0.5
    Water tanker
0.55 -0.20, 1.3 0.2
1 Adjusted for age, gender, house type, rural/urban, and wealth index
Abbreviation: CI = Confidence Interval

B. Micronutrient deficiency

Characteristic N Adj. β (95% CI)1 95% CI p-value
Anemia status 4,286


    No Anemia

    Any Anemia
0.44 0.20, 0.69 <0.001
Anaemia Status (Any, New) 4,286


    No Anemia

    Mild Anemia
0.32 0.02, 0.61 0.039
    Moder+Sev Anemia
0.61 0.28, 0.94 <0.001
iron_def_adj 875


    No Iron Deficiency

    Iron Deficiency
0.47 -0.02, 0.95 0.062
Anaemia Adjusted for Iron 906


    No Anemia + Iron Deficiency

    Anemia + No Iron Deficiency
0.81 -0.39, 2.0 0.2
    No Anemia + No Iron Deficiency
1.1 -0.06, 2.2 0.064
    Anemia + Iron Deficiency
1.5 -0.14, 3.1 0.072
Vitamin B12 Status 869


    Normal (≥203 pg/mL)

    Deficient (<203 pg/mL)
-0.08 -0.59, 0.43 0.7
Serum Folate Status 868


    Normal (≥4 ng/mL)

    Deficient (<4 ng/mL)
-0.25 -0.98, 0.48 0.5
Vitamin D Status 865


    Normal (≥12 ng/mL)

    Deficient (<12 ng/mL)
0.27 -0.39, 0.93 0.4
1 Adjusted for age, gender, house type, rural/urban, and wealth index
Abbreviation: CI = Confidence Interval

C. Malnutrition status

Characteristic N Adj. β (95% CI)1 95% CI p-value
Stunting status 3,513


    No Stunting

    Stunting
0.37 0.04, 0.70 0.029
    Severe Stunting
0.96 0.53, 1.4 <0.001
Wasting status 3,480


    No Wasting

    Wasting
0.18 -0.23, 0.59 0.4
    Severe Wasting
0.07 -0.72, 0.86 0.9
Underweight status 3,538


    No Underweight

    Underweight
0.57 0.23, 0.90 <0.001
    Severe Underweight
0.63 0.12, 1.1 0.015
MUAC Group 3,545


    Normal

    severewasting
0.16 -0.67, 0.99 0.7
1 Adjusted for age, gender, house type, rural/urban, and wealth index
Abbreviation: CI = Confidence Interval

D. Dietary poor in micronutrients

Adjusted Linear Regression: Effect of 10-unit Nutrient Increase on Blood Pb
Variable Beta 95% CI Lower 95% CI Upper P_Value
Energy Intake (kcal/day) -0.002 -0.004 0.000 0.0670
Protein Intake (g/day) -0.103 -0.168 -0.037 0.0021
Carbohydrate Intake (g/day) -0.008 -0.020 0.005 0.2253
Total Fat Intake (g/day) -0.070 -0.142 0.002 0.0557
Iron Intake (mg/day) -0.268 -0.480 -0.057 0.0129
Zinc Intake (mg/day) -0.414 -0.753 -0.075 0.0168
Calcium Intake (mg/day) -0.009 -0.015 -0.004 0.0012
Thiamine (B1) Intake (mg/day) -2.972 -5.291 -0.653 0.0120
Riboflavin (B2) Intake (mg/day) -6.205 -10.118 -2.293 0.0019
Niacin (B3) Intake (mg/day) -0.378 -0.690 -0.065 0.0178
Total Folate (B9) Intake (ug/day) -0.037 -0.056 -0.019 0.0001
Vitamin C Intake (mg/day) -0.049 -0.091 -0.007 0.0235
Vitamin A Intake (ug/day) -0.011 -0.019 -0.002 0.0159
Vitamin B12 Intake (ug/day) -0.324 -2.003 1.355 0.7052
Birth Weight (grams) 0.003 -0.004 0.011 0.3937
Note:
Adjusted for age, gender, house type, rural/urban, and wealth index