背景:卫生污水溢出(SSO)释放原污水,这可能会污染饮用水供应。在低压或负压事件期间发布沸水咨询(BWA),提醒客户注意饮用水分配系统中的潜在污染。
目的:我们评估了哥伦比亚SSO和BWA与胃肠道(GI)疾病诊断之间的关联,南卡罗来纳州,和邻近的社区,2013-2017。
方法:采用对称双向病例交叉研究设计,评估SSO和BWA在急诊就诊和急诊就诊中的作用,并初步诊断为胃肠道疾病。如果SSO或BWA发生0-4天,病例被认为是暴露的,5-9天,或诊断前10-14天,在同一住宅邮政编码内。通过对参与者水平因素进行分层来探索效果修改(例如,性别,种族,年龄)和季节(1月至3月与4月至12月)。
结果:有830个SSO,423BWA,和25,969例胃肠道疾病。SSO数量最多的,在邮政编码中观察到BWA和GI病例,其中>80%的居民被确定为黑人或非裔美国人。SSO与在0-4天的危险期内诊断为胃肠道疾病的几率增加13%相关。与对照期相比(赔率:1.13,95%置信区间:1.09,1.18),而在其他危险时期没有观察到关联。在所有三个危险期中,BWA与胃肠道疾病的几率升高或降低无关。然而,在1月至3月之间发布的BWA分层分析中,胃肠道疾病的几率较高,与4月至12月之间发布的咨询相比,在所有三个危险时期。
结论:SSO(所有月份)和BWAs(1月至3月)与胃肠道疾病诊断的几率增加相关。未来的研究应该检查饮用水分配系统的污水污染,以及污水从SSO侵入的机制。
结论:污水中含有病原体,导致胃肠道(GI)疾病。在哥伦比亚,南卡罗来纳州,美国,2013-2017年间,共有830次生活污水溢出(SSO)。还有423份开水咨询,在负压事件期间发布。使用案例交叉设计,SSO(所有月份)和开水咨询(1月至3月)与急诊室和紧急护理诊断胃肠道疾病的几率增加有关,可能是由于饮用水分配系统的污染。最后,我们确定了一个社区,其中>80%的居民被确定为黑人或非裔美国人,经历了不成比例的污水暴露负担,与哥伦比亚其他地区相比。
Sanitary sewage overflows (SSOs) release raw sewage, which may contaminate the drinking water supply. Boil water advisories (BWAs) are issued during low or negative pressure events, alerting customers to potential contamination in the drinking water distribution system.
We evaluated the associations between SSOs and BWAs and diagnoses of gastrointestinal (GI) illness in Columbia, South Carolina, and neighboring communities, 2013-2017.
A symmetric bi-directional
case-crossover study design was used to assess the role of SSOs and BWAs on Emergency Room and Urgent Care visits with a primary diagnosis of GI illness. Cases were considered exposed if an SSO or BWA occurred 0-4 days, 5-9 days, or 10-14 days prior to the diagnosis, within the same residential zip code. Effect modification was explored via stratification on participant-level factors (e.g., sex, race, age) and season (January-March versus April-December).
There were 830 SSOs, 423 BWAs, and 25,969 cases of GI illness. Highest numbers of SSOs, BWAs and GI cases were observed in a zip code where >80% of residents identified as Black or African-American. SSOs were associated with a 13% increase in the odds of a diagnosis for GI illness during the 0-4 day hazard period, compared to control periods (Odds Ratio: 1.13, 95% Confidence Interval: 1.09, 1.18), while no associations were observed during the other hazard periods. BWAs were not associated with increased or decreased odds of GI illness during all three hazard periods. However, in stratified analyses BWAs issued between January-March were associated with higher odds of GI illness, compared to advisories issued between April-December, in all three hazard periods.
SSOs (all months) and BWAs (January-March) were associated with increased odds of a diagnosis of GI illness. Future research should examine sewage contamination of the drinking water distribution system, and mechanisms of sewage intrusion from SSOs.
Sewage contains pathogens, which cause gastrointestinal (GI) illness. In Columbia, South Carolina, USA, between 2013-2017, there were 830 sanitary sewage overflows (SSOs). There were also 423 boil water advisories, which were issued during negative pressure events. Using
case-crossover design, SSOs (all months) and boil water advisories (January-March) were associated with increased odds of Emergency Room and Urgent Care diagnoses of GI illness, potentially due to contamination of the drinking water distribution system. Lastly, we identified a community where >80% of residents identified as Black or African-American, which experienced a disproportionate burden of sewage exposure, compared to the rest of Columbia.