Drinking Water and Gastrointestinal Illness in Atlanta, 1993 - 2004 Open Access
Tinker, Sarah Ceaser (2007)
Published
Abstract
Previous research has suggested municipal drinking water may contribute to endemic gastrointestinal (GI) illness in the U.S., but the results were inconsistent, and the burden of GI illness attributable to drinking water contamination remains unclear. Three studies were conducted to examine the population impact of multiple surrogates of drinking water quality in Atlanta, Georgia. These analyses made use of an extensive emergency department (ED) database containing information on more than 10 million visits made to 41 hospitals between 1993 and 2004. The first of these studies considered the association of GI illness with an estimate of the time taken by drinking water to travel from the treatment plant to the end user (water residence time). The second study examined the role of the drinking water treatment plant itself as a risk factor for GI illness, as source water quality and treatment methods differ by plant. The final study examined the association between turbidity, the primary indicator of drinking water quality used by utilities, and ED visits for GI illness using time-series methods. The results support roles for both the raw water source and the distribution system as sites of drinking water contamination. Filtered water turbidity, a primary water quality measure used by the utilities, did not appear to predict risk. Overall, these studies suggest that a low level of GI illness in Atlanta may be attributable to drinking water exposure, particularly among young children and the elderly.
Table of Contents
Chapter
1 INTRODUCTION
2 LITERATURE REVIEW: GASTROINTESTINAL ILLNESS
Gastrointestinal Disease Processes
Causes of Gastrointestinal Illness
Organisms Causing Waterborne Gastrointestinal Illness
Susceptible Subpopulations
Routes of Waterborne Disease Transmission
3 LITERATURE REVIEW: MICROBIAL DRINKING WATER QUALITY
Drinking Water Treatment and Distribution
Indicators of Water Quality
Drinking Water Regulations in the U.S.
4 LITERATURE REVIEW: THE RELATIONSHIP BETWEEN DRINKING WATER AND GASTROINTESTINAL ILLNESS IN THE U.S
Drinking Water-Related Disease Outbreaks
Randomized-Controlled Interventional Trials
Time-Series Studies
Other Observational Studies
Conclusion
5 PROJECT DESIGN AND ANALYSIS PLAN
Dissertation Goals
Research Project Design
Research Project Population
Water Quality Information
Emergency Department Visit Information
Covariate Information
Epidemiologic Analyses
Regression Diagnostics
Power
Limitations
Contributions
6 DRINKING WATER RESIDENCE TIME AND EMERGENCY DEPARTMENT VISITS FOR GASTROINESTINAL ILLNESS IN ATLANTA, 1996 - 2003
Abstract
Introduction
Methods
Results
Discussion
References
7 DRINKING WATER TREATMENT PLANTS AND EMERGENCY DEPARTMENT VISITS FOR GASTROINTESTINAL ILLNESS IN ATLANTA, 1993 - 2004
Abstract
Introduction
Methods
Results
Discussion
References
8 DRINKING WATER TURBIDITY AND EMERGENCY DEPARTMENT VISITS FOR GASTROINTESTINAL ILLNESS IN ATLANTA, 1993 - 2004
Abstract
Introduction
Methods
Results
References
9 CONCLUSIONS
10 REFERENCES
Appendix
A ADDITIONAL ANALYSIS OF DRINKING WATER RESIDENCE TIME AND EMERGENCY DEPARTMENT VISITS FOR GASTROINTESTINAL ILLNESS IN ATLANTA, 1996 - 2003
B ADDITIONAL ANALYSIS OF DRINKING WATER TREATMENT PLANTS AND EMERGENCY DEPARTMENT VISITS FOR GASTROINTESTINAL ILLNESS IN ATLANTA, 1993 -2004
C ADDITIONAL ANALYSIS OF DRINKING WATER TURBIDITY AND EMERGENCY DEPARTMENT VISITS FOR GASTROINTESTINAL ILLNESS IN ATLANTA, 1993 - 2004
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