’As safe as houses; the risk of childhood lead exposure from housing in England and implications for public health’

Helen Crabbe*, Neville Q. Verlander, Neelam Iqbal, Rebecca Close, Geraldine White, Giovanni S. Leonardi, Araceli Busby

*Corresponding author for this work

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Background and aim: Exposure to lead can harm a child’s health, including damage to the nervous system, delayed growth, hearing loss, and many other adverse health effects, as well as implications for social, economic, educational and social well-being. Lead exposure in children is still a concern and cases require public health management to find the exposure source and interrupt the exposure pathway. Housing characteristics can indicate the presence of lead-contaminated paint and leaded water supply pipes. We aimed to explore the relationship between housing characteristics and elevated blood lead concentration (BLC) in children in England. 

Methods: We used a retrospective cohort design and included all cases of lead exposure in children reported to the UK Health Security Agency between 2014 and 2020 via surveillance. A case was a child aged under 16 years, resident in England, BLC of ≥ 0.48 μmol/L (10 µg/dL) and referred for public health management. We collected case demographic details and housing characteristics (age and type). We explored associations between elevated BLC and risk factors, using generalised linear mixed effects models and compared cases’ housing type to that expected nationally. 

Results: Two hundred and sixty-six out of 290 cases met the case definition. There was no difference in BLCs between genders, age groups, deprivation, and housing type. After adjusting for reporting source, housing age and type, cases residing in housing built pre-1976 had a BLC of 0.32 (95%CI 0.02, 0.63) µmols/L (6.63 (95%CI 0.42, 13.0) µg/dL) higher than cases living in housing built after this time. Cases were 1.68 times more likely to be living in terraced housing (housing adjoined to one another) than other children and less likely to live in apartments and detached properties. 

Conclusion: This study suggests an association between housing characteristics and BLC in children. Housing age and type may act as a proxy for lead exposure risk through exposure to leaded paint, lead water pipes, and lead contaminated dust from indoor and outdoor sources. Public health action should consider targeting families more at risk in older housing by raising awareness of the potential presence of lead pipes and paint. Interventions should include working with wider stakeholders including other housing and environmental professionals, the private sector, as well as parents and carers.

Original languageEnglish
Article number2052
JournalBMC Public Health
Issue number1
Early online date9 Nov 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information: Routine work undertaken by UKHSA as part of public health response. The research was part-supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Environmental Exposures and
Health, a partnership between UK Health Security Agency, the Health and Safety Executive and the University of Leicester.

Open Access: This article contains public sector information licensed under the Open Government Licence v3.0, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Open Government licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Open Government licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Open Government licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
http:// www.nationalarchives.gov.uk/doc/open- government- licence/version/3/.

Publisher Copyright: © Crown 2022.

Citation: Crabbe, H., Verlander, N.Q., Iqbal, N. et al. ’As safe as houses; the risk of childhood lead exposure from housing in England and implications for public health’. BMC Public Health 22, 2052 (2022). https://doi.org/10.1186/s12889-022-14350-y

DOI: https://doi.org/10.1186/s12889-022-14350-y


  • Blood lead concentration
  • Children
  • England
  • Epidemiology
  • Exposure
  • Housing
  • Lead
  • Paint
  • Surveillance
  • Water pipes


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