Water and sewage systems, socio-demographics, and duration of residence associated with endemic intestinal infectious diseases: A cohort study

BMC Public Health

Research Article

Jim Atwater¹  Judith L Isaac-Renton²  Hans Schreier³  Neil Bellack⁴  Rong Chu⁴  Mieke Koehoorn⁴  Ying C MacNab⁴  Kay Teschke⁴  Hui Shen⁴ 

[1] Department of Civil Engineering, University of British Columbia, Vancouver, Canada;Department of Pathology and Laboratory Medicine, University of British Columbia and BC Centre for Disease Control, Vancouver, Canada;Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, Canada;School of Population and Public Health, University of British Columbia, Vancouver, Canada;

关键词: Physician Visit;    British Columbia;    Sewage Disposal;    Gastrointestinal Illness;    Crude Incidence Rate;   

DOI  :  10.1186/1471-2458-10-767

 received in 2010-02-24, accepted in 2010-12-16,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundStudies of water-related gastrointestinal infections are usually directed at outbreaks. Few have examined endemic illness or compared rates across different water supply and sewage disposal systems. We conducted a cohort study of physician visits and hospitalizations for endemic intestinal infectious diseases in a mixed rural and urban community near Vancouver, Canada, with varied and well-characterized water and sewage systems.MethodsCohort members and their disease events were defined via universal health insurance data from 1995 through 2003. Environmental data were derived from municipal, provincial, and federal government sources. Logistic regression was used to examine associations between disease events and water and sewage systems, socio-demographic characteristics, and temporal factors.ResultsThe cohort included 126,499 individuals and approximately 190,000,000 person-days. Crude incidence rates were 1,353 physician visits and 33.8 hospitalizations for intestinal infectious diseases per 100,000 person-years. Water supply chlorination was associated with reduced physician visit incidence (OR: 0.92, 95% CI 0.85-1.0). Two water systems with the highest proportions of surface water had increased incidence (ORs: 1.57, 95% CI 1.39-1.78; and 1.45, 95% CI 1.28-1.64). Private well water and well depth were not associated with increased risk, likely because of residents' awareness of and attention to water quality. There was increased crude incidence with increasing precipitation in the population served by surface water supplies, but this trend did not remain with adjustment for other variables. Municipal sewer systems were associated with increased risk (OR: 1.26, 95% CI 1.14-1.38). Most socio-demographic variables had predicted associations with risk: higher rates in females, in the very young and the elderly, and in residents of low income areas. Increased duration of area residence was associated with reduced risk (OR, duration ≥ 6 years: 0.69, 95% CI 0.60-0.80 vs. < 1 year: 1.16, 95% CI 1.03-1.30).ConclusionsThis large cohort study, with objective data on exposures and outcomes, demonstrated associations between endemic infectious intestinal diseases and factors related to water supply, sewage disposal, socio-demographics, and duration of residency. The results did not always follow prior expectations based on studies examining outbreaks and single systems, and underscore the importance of studying factors associated with endemic disease across water and sewage system types.

【 授权许可】

CC BY   
© Teschke et al; licensee BioMed Central Ltd. 2010