Drinking Water and Gastrointestinal Illness in Atlanta, 1993 - 2004 Open Access

Tinker, Sarah Ceaser (2007)

Permanent URL: https://etd.library.emory.edu/concern/etds/dr26xz07b?locale=en
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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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