title: The relationship between in-home water service and the risk of respiratory tract, skin, and gastrointestinal tract infections among rural Alaska natives.
abstract: OBJECTIVE
  We investigated the relationship between the presence of in-home piped water and wastewater services and hospitalization rates for respiratory tract, skin, and gastrointestinal tract infections in rural Alaska.
  
  
  METHODS
  We determined in-home water service and hospitalizations for selected infectious diseases among Alaska Natives by region during 2000 to 2004. Within 1 region, infant respiratory hospitalizations and skin infections for all ages were compared by village-level water services.
  
  
  RESULTS
  Regions with a lower proportion of home water service had significantly higher hospitalization rates for pneumonia and influenza (rate ratio [RR] = 2.5), skin or soft tissue infection (RR = 1.9), and respiratory syncytial virus (RR = 3.4 among those younger than 5 years) than did higher-service regions. Within 1 region, infants from villages with less than 10% of homes served had higher hospitalization rates for pneumonia (RR = 1.3) and respiratory syncytial virus (RR = 1.2) than did infants from villages with more than 80% served. Outpatient Staphylococcus aureus infections (RR = 5.1, all ages) and skin infection hospitalizations (RR = 2.7, all ages) were higher in low-service than in high-service villages.
  
  
  CONCLUSIONS
  Higher respiratory and skin infection rates were associated with a lack of in-home water service. This disparity should be addressed through sanitation infrastructure improvements.
authors.affiliation: Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, AK, USA. thennessy@cdc.gov
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Troy
authors.initials: T
authors.lastname: Ritter
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Dana L
authors.initials: DL
authors.lastname: Bruden
authors.forename: Krista L
authors.initials: KL
authors.lastname: Yorita
authors.forename: Lisa
authors.initials: L
authors.lastname: Bulkow
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: Jeff
authors.initials: J
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006798:Housing / Q000145:classification*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology / Q000208:ethnology; D004930:Inuit / Q000706:statistics & numerical data*; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000208:ethnology; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000208:ethnology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000208:ethnology*; D018570:Risk Assessment; D012423:Rural Health / Q000706:statistics & numerical data*; D012874:Skin Diseases, Infectious / Q000453:epidemiology* / Q000208:ethnology; D014881:Water Supply