title: Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia.
abstract: We examined whether the average water residence time, the time it takes water to travel from the treatment plant to the user, for a zip code was related to the proportion of emergency department (ED) visits for gastrointestinal (GI) illness among residents of that zip code. Individual-level ED data were collected from all hospitals located in the five-county metro Atlanta area from 1993 to 2004. Two of the largest water utilities in the area, together serving 1.7 million people, were considered. People served by these utilities had almost 3 million total ED visits, 164,937 of them for GI illness. The relationship between water residence time and risk for GI illness was assessed using logistic regression, controlling for potential confounding factors, including patient age and markers of socioeconomic status (SES). We observed a modestly increased risk for GI illness for residents of zip codes with the longest water residence times compared with intermediate residence times (odds ratio (OR) for Utility 1 = 1.07, 95% confidence interval (CI) = 1.03, 1.10; OR for Utility 2 = 1.05, 95% CI = 1.02, 1.08). The results suggest that drinking water contamination in the distribution system may contribute to the burden of endemic GI illness.
authors.affiliation: Department of Environmental and Occupational Health, Emory University, Atlanta, GA 30322, USA. sceaser@sph.emory.edu
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Tinker
authors.forename: Christine L
authors.initials: CL
authors.lastname: Moe
authors.forename: Mitchel
authors.initials: M
authors.lastname: Klein
authors.forename: W Dana
authors.initials: WD
authors.lastname: Flanders
authors.forename: Jim
authors.initials: J
authors.lastname: Uber
authors.forename: Appiah
authors.initials: A
authors.lastname: Amirtharajah
authors.forename: Philip
authors.initials: P
authors.lastname: Singer
authors.forename: Paige E
authors.initials: PE
authors.lastname: Tolbert
mesh_terms: D000367:Age Factors; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D005845:Georgia / Q000453:epidemiology; D008962:Models, Theoretical; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013997:Time Factors; D014504:Urban Health / Q000706:statistics & numerical data; D014881:Water Supply / Q000706:statistics & numerical data*