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Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003-2007.

Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED - Environ. Health Perspect. (2015)

Bottom Line: Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources.Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall.Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015.

View Article: PubMed Central - PubMed

Affiliation: Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Illinois, USA.

ABSTRACT

Background: Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change.

Objectives: The aim of this study was to assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed in the presence of CSOs.

Methods: For the study period 2003-2007, time series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: a) CSOs impacting drinking water sources, b) CSOs impacting recreational waters, c) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥ 90th and ≥ 95th percentile) and extreme (≥ 99th percentile) precipitation events, controlling for temperature and long-term time trends.

Results: The association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall.

Conclusions: The rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for GI illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation.

Citation: Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015. Extreme precipitation and emergency room visits for gastrointestinal illness in areas with and without combined sewer systems: an analysis of Massachusetts data, 2003-2007. Environ Health Perspect 123:873-879; http://dx.doi.org/10.1289/ehp.1408971.

No MeSH data available.


Related in: MedlinePlus

Three exposure classification regions, with classification based on the type of CSO facilities in towns. N/A, not applicable.
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f1: Three exposure classification regions, with classification based on the type of CSO facilities in towns. N/A, not applicable.

Mentions: Exposure classification. Locations of CSO outfalls in Massachusetts were obtained from U.S. EPA Enforcement and Compliance History Online System (U.S. EPA 2014b). We considered three regions for analysis: one with recreational water exposure to CSOs (exposed–recreational water region), one with drinking water exposure to CSOs (exposed–drinking water region), and an area without exposure to CSOs (unexposed region) (Figure 1). In the exposed–recreational water region, CSOs discharge directly into a water body used for recreation, the Boston Harbor. This region included 24 neighboring cities and towns surrounding the harbor likely to recreate in the harbor. Boston Harbor is typically used for sailing, fishing, kayaking, and recreational activities with limited direct water contact. In the exposed–drinking water region, which included 11 neighboring towns, CSOs discharge into river waters used as a drinking water source. Despite being a historically industrial and polluted waterway, the Merrimack River, which serves this region, is the only river in New England from which communities draw drinking water directly (Leo 2014). The unexposed region included 9 neighboring towns that do not have CSO outfalls.


Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003-2007.

Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED - Environ. Health Perspect. (2015)

Three exposure classification regions, with classification based on the type of CSO facilities in towns. N/A, not applicable.
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559956&req=5

f1: Three exposure classification regions, with classification based on the type of CSO facilities in towns. N/A, not applicable.
Mentions: Exposure classification. Locations of CSO outfalls in Massachusetts were obtained from U.S. EPA Enforcement and Compliance History Online System (U.S. EPA 2014b). We considered three regions for analysis: one with recreational water exposure to CSOs (exposed–recreational water region), one with drinking water exposure to CSOs (exposed–drinking water region), and an area without exposure to CSOs (unexposed region) (Figure 1). In the exposed–recreational water region, CSOs discharge directly into a water body used for recreation, the Boston Harbor. This region included 24 neighboring cities and towns surrounding the harbor likely to recreate in the harbor. Boston Harbor is typically used for sailing, fishing, kayaking, and recreational activities with limited direct water contact. In the exposed–drinking water region, which included 11 neighboring towns, CSOs discharge into river waters used as a drinking water source. Despite being a historically industrial and polluted waterway, the Merrimack River, which serves this region, is the only river in New England from which communities draw drinking water directly (Leo 2014). The unexposed region included 9 neighboring towns that do not have CSO outfalls.

Bottom Line: Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources.Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall.Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015.

View Article: PubMed Central - PubMed

Affiliation: Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Illinois, USA.

ABSTRACT

Background: Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change.

Objectives: The aim of this study was to assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed in the presence of CSOs.

Methods: For the study period 2003-2007, time series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: a) CSOs impacting drinking water sources, b) CSOs impacting recreational waters, c) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥ 90th and ≥ 95th percentile) and extreme (≥ 99th percentile) precipitation events, controlling for temperature and long-term time trends.

Results: The association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall.

Conclusions: The rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for GI illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation.

Citation: Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015. Extreme precipitation and emergency room visits for gastrointestinal illness in areas with and without combined sewer systems: an analysis of Massachusetts data, 2003-2007. Environ Health Perspect 123:873-879; http://dx.doi.org/10.1289/ehp.1408971.

No MeSH data available.


Related in: MedlinePlus