title: Estimated Costs of Sporadic Gastrointestinal Illness Associated with Surface Water Recreation: A Combined Analysis of Data from NEEAR and CHEERS Studies.
abstract: The burden of illness can be described by addressing both incidence and illness severity attributable to water recreation. Monetized as cost, attributable disease burden estimates can be useful for environmental management decisions.
  
  
  
  We characterize the disease burden attributable to water recreation using data from two cohort studies using a cost of illness (COI) approach and estimate the largest drivers of the disease burden of water recreation.
  
  
  
  Data from the NEEAR study, which evaluated swimming and wading in marine and freshwater beaches in six U.S. states, and CHEERS, which evaluated illness after incidental-contact recreation (boating, canoeing, fishing, kayaking, and rowing) on waterways in the Chicago area, were used to estimate the cost per case of gastrointestinal illness and costs attributable to water recreation. Data on health care and medication utilization and missed days of work or leisure were collected and combined with cost data to construct measures of COI.
  
  
  
  Depending on different assumptions, the cost of gastrointestinal symptoms attributable to water recreation are estimated to be $1,220 for incidental-contact recreation (range $338-$1,681) and $1,676 for swimming/wading (range $425-2,743) per 1,000 recreators. Lost productivity is a major driver of the estimated COI, accounting for up to 90% of total costs.
  
  
  
  Our estimates suggest gastrointestinal illness attributed to surface water recreation at urban waterways, lakes, and coastal marine beaches is responsible for costs that should be accounted for when considering the monetary impact of efforts to improve water quality. The COI provides more information than the frequency of illness, as it takes into account disease incidence, health care utilization, and lost productivity. Use of monetized disease severity information should be included in future studies of water quality and health. Citation: DeFlorio-Barker S, Wade TJ, Jones RM, Friedman LS, Wing C, Dorevitch S. 2017. Estimated costs of sporadic gastrointestinal illness associated with surface water recreation: a combined analysis of data from NEEAR and CHEERS Studies. Environ Health Perspect 125:215-222; http://dx.doi.org/10.1289/EHP130.
authors.affiliation: Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Illinois, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: DeFlorio-Barker
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wade
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Jones
authors.forename: Lee S
authors.initials: LS
authors.lastname: Friedman
authors.forename: Coady
authors.initials: C
authors.lastname: Wing
authors.forename: Samuel
authors.initials: S
authors.lastname: Dorevitch
mesh_terms: D001493:Bathing Beaches / Q000706:statistics & numerical data*; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D017281:Cost of Illness; D005618:Fresh Water / Q000382:microbiology; D005767:Gastrointestinal Diseases / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D011998:Recreation; D018570:Risk Assessment; D013550:Swimming; D014871:Water Microbiology; D060753:Water Quality