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. 2000 Jan;54(1):45–51. doi: 10.1136/jech.54.1.45

Drinking water turbidity and gastrointestinal illness in the elderly of Philadelphia

J Schwartz 1, R Levin 1, R Goldstein 1
PMCID: PMC1731533  PMID: 10692962

Abstract

STUDY OBJECTIVE—To investigate the association between drinking water quality and gastrointestinal illness in the elderly of Philadelphia.
DESIGN—Within the general population, children and the elderly are at highest risk for gastrointestinal disease. This study investigates the potential association between daily fluctuations in drinking water turbidity and subsequent hospital admissions for gastrointestinal illness of elderly persons, controlling for time trends, seasonal patterns, and temperature using Poisson regression analysis.
SETTING AND PARTICIPANTS—All residents of Philadelphia aged 65 and older in 1992-1993 were studied through their MEDICARE records.
MAIN RESULTS—For Philadelphia's population aged 65 and older, we found water quality 9 to 11 days before the visit was associated with hospital admissions for gastrointestinal illness, with an interquartile range increase in turbidity being associated with a 9% increase (95% CI 5.3%, 12.7%). In the Belmont service area, there was also an association evident at a lag of 4 to 6 days (9.1% increase, 95% CI 5.2, 13.3). Both associations were stronger in those over 75 than in the population aged 65-74. This association occurred in a filtered water supply in compliance with US standards.
CONCLUSIONS—Elderly residents of Philadelphia remain at risk of waterborne gastrointestinal illness under current water treatment practices. Hospitalisations represent a very small percentage of total morbidity.


Keywords: waterborne disease; drinking water; gastrointestinal illness; elderly

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Selected References

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  1. Anderson H. R., Spix C., Medina S., Schouten J. P., Castellsague J., Rossi G., Zmirou D., Touloumi G., Wojtyniak B., Ponka A. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. Eur Respir J. 1997 May;10(5):1064–1071. doi: 10.1183/09031936.97.10051064. [DOI] [PubMed] [Google Scholar]
  2. Baert D., De Man M., Oosterbosch L., Duyck M. C., Van der Spek P., Lepoutre L. Infectious gastroenteritis: are they all the same? Acta Clin Belg. 1995;50(5):269–273. doi: 10.1080/17843286.1995.11718460. [DOI] [PubMed] [Google Scholar]
  3. Bates D. V., Sizto R. Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect. Environ Res. 1987 Aug;43(2):317–331. doi: 10.1016/s0013-9351(87)80032-4. [DOI] [PubMed] [Google Scholar]
  4. Burnett R. T., Dales R. E., Raizenne M. E., Krewski D., Summers P. W., Roberts G. R., Raad-Young M., Dann T., Brook J. Effects of low ambient levels of ozone and sulfates on the frequency of respiratory admissions to Ontario hospitals. Environ Res. 1994 May;65(2):172–194. doi: 10.1006/enrs.1994.1030. [DOI] [PubMed] [Google Scholar]
  5. Delfino R. J., Becklake M. R., Hanley J. A. Reliability of hospital data for population-based studies of air pollution. Arch Environ Health. 1993 May-Jun;48(3):140–146. doi: 10.1080/00039896.1993.9940812. [DOI] [PubMed] [Google Scholar]
  6. Gangarosa R. E., Glass R. I., Lew J. F., Boring J. R. Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol. 1992 Feb 1;135(3):281–290. doi: 10.1093/oxfordjournals.aje.a116282. [DOI] [PubMed] [Google Scholar]
  7. Garibaldi R. A., Brodine S., Matsumiya S. Infections among patients in nursing homes: policies, prevalence, problems. N Engl J Med. 1981 Sep 24;305(13):731–735. doi: 10.1056/NEJM198109243051304. [DOI] [PubMed] [Google Scholar]
  8. Goldstein S. T., Juranek D. D., Ravenholt O., Hightower A. W., Martin D. G., Mesnik J. L., Griffiths S. D., Bryant A. J., Reich R. R., Herwaldt B. L. Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment. Ann Intern Med. 1996 Mar 1;124(5):459–468. doi: 10.7326/0003-4819-124-5-199603010-00001. [DOI] [PubMed] [Google Scholar]
  9. Hayes E. B., Matte T. D., O'Brien T. R., McKinley T. W., Logsdon G. S., Rose J. B., Ungar B. L., Word D. M., Pinsky P. F., Cummings M. L. Large community outbreak of cryptosporidiosis due to contamination of a filtered public water supply. N Engl J Med. 1989 May 25;320(21):1372–1376. doi: 10.1056/NEJM198905253202103. [DOI] [PubMed] [Google Scholar]
  10. Hoxie N. J., Davis J. P., Vergeront J. M., Nashold R. D., Blair K. A. Cryptosporidiosis-associated mortality following a massive waterborne outbreak in Milwaukee, Wisconsin. Am J Public Health. 1997 Dec;87(12):2032–2035. doi: 10.2105/ajph.87.12.2032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hsia D. C., Ahern C. A., Ritchie B. P., Moscoe L. M., Krushat W. M. Medicare reimbursement accuracy under the prospective payment system, 1985 to 1988. JAMA. 1992 Aug 19;268(7):896–899. [PubMed] [Google Scholar]
  12. Hsia D. C., Krushat W. M., Fagan A. B., Tebbutt J. A., Kusserow R. P. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med. 1988 Feb 11;318(6):352–355. doi: 10.1056/NEJM198802113180604. [DOI] [PubMed] [Google Scholar]
  13. Jeandel C., Laurain M. C., Decottignies F. Diarrhées infectieuses du sujet âgé. Rev Prat. 1996 Jan 15;46(2):184–188. [PubMed] [Google Scholar]
  14. Kelsall J. E., Samet J. M., Zeger S. L., Xu J. Air pollution and mortality in Philadelphia, 1974-1988. Am J Epidemiol. 1997 Nov 1;146(9):750–762. doi: 10.1093/oxfordjournals.aje.a009351. [DOI] [PubMed] [Google Scholar]
  15. Kent G. P., Greenspan J. R., Herndon J. L., Mofenson L. M., Harris J. A., Eng T. R., Waskin H. A. Epidemic giardiasis caused by a contaminated public water supply. Am J Public Health. 1988 Feb;78(2):139–143. doi: 10.2105/ajph.78.2.139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. LeChevallier M. W., Norton W. D., Lee R. G. Occurrence of Giardia and Cryptosporidium spp. in surface water supplies. Appl Environ Microbiol. 1991 Sep;57(9):2610–2616. doi: 10.1128/aem.57.9.2610-2616.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Lew J. F., Glass R. I., Gangarosa R. E., Cohen I. P., Bern C., Moe C. L. Diarrheal deaths in the United States, 1979 through 1987. A special problem for the elderly. JAMA. 1991 Jun 26;265(24):3280–3284. [PubMed] [Google Scholar]
  18. Mac Kenzie W. R., Hoxie N. J., Proctor M. E., Gradus M. S., Blair K. A., Peterson D. E., Kazmierczak J. J., Addiss D. G., Fox K. R., Rose J. B. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994 Jul 21;331(3):161–167. doi: 10.1056/NEJM199407213310304. [DOI] [PubMed] [Google Scholar]
  19. Morris R. D., Naumova E. N., Levin R., Munasinghe R. L. Temporal variation in drinking water turbidity and diagnosed gastroenteritis in Milwaukee. Am J Public Health. 1996 Feb;86(2):237–239. doi: 10.2105/ajph.86.2.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Payment P., Richardson L., Siemiatycki J., Dewar R., Edwardes M., Franco E. A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards. Am J Public Health. 1991 Jun;81(6):703–708. doi: 10.2105/ajph.81.6.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Ponce de Leon A., Anderson H. R., Bland J. M., Strachan D. P., Bower J. Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987-88 and 1991-92. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s63–s70. doi: 10.1136/jech.50.suppl_1.s63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Schwartz J. Air pollution and hospital admissions for the elderly in Birmingham, Alabama. Am J Epidemiol. 1994 Mar 15;139(6):589–598. doi: 10.1093/oxfordjournals.aje.a117048. [DOI] [PubMed] [Google Scholar]
  23. Schwartz J., Levin R., Hodge K. Drinking water turbidity and pediatric hospital use for gastrointestinal illness in Philadelphia. Epidemiology. 1997 Nov;8(6):615–620. doi: 10.1097/00001648-199710000-00001. [DOI] [PubMed] [Google Scholar]
  24. Schwartz J. PM10, ozone, and hospital admissions for the elderly in Minneapolis-St. Paul, Minnesota. Arch Environ Health. 1994 Sep-Oct;49(5):366–374. doi: 10.1080/00039896.1994.9954989. [DOI] [PubMed] [Google Scholar]
  25. Schwartz J. Short term fluctuations in air pollution and hospital admissions of the elderly for respiratory disease. Thorax. 1995 May;50(5):531–538. doi: 10.1136/thx.50.5.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Sims R. V., Hauser R. J., Adewale A. O., Maislin G., Skeie S., Lavizzo-Mourey R. J., Rubin H. Acute gastroenteritis in three community-based nursing homes. J Gerontol A Biol Sci Med Sci. 1995 Sep;50(5):M252–M256. doi: 10.1093/gerona/50a.5.m252. [DOI] [PubMed] [Google Scholar]
  27. Thurston G. D., Ito K., Kinney P. L., Lippmann M. A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers. J Expo Anal Environ Epidemiol. 1992 Oct-Dec;2(4):429–450. [PubMed] [Google Scholar]

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