Pediatric emergency department visits for diarrheal illness increased after release of undertreated sewage

Medical College of Wisconsin, Milwaukee, Wisconsin, United States
PEDIATRICS (Impact Factor: 5.3). 12/2007; 120(6):e1472-5. DOI: 10.1542/peds.2007-0283
Source: PubMed

ABSTRACT Contamination of local waterways may occur through release of partially treated sewage. The Environmental Protection Agency has recently reviewed regulatory standards for this practice. However, the health effects of these events have not been well studied.
Our goal was to identify any increase in visits to a pediatric emergency department for diarrheal illness after sewage bypass into Lake Michigan.
The study was conducted as a retrospective, observational time-series analysis in a tertiary care children's hospital emergency department with an annual volume of approximately 45,000 visits. We collected data for 2002-2004 pertaining to the daily number of emergency department visits for children (aged <19 years) for diarrheal illness (using specified International Classification of Diseases, Ninth Edition codes as a reference). Daily diarrheal illness visits were the dependent variable in a time-series model. The primary independent variable was the occurrence of a sewage-bypass event in the 3 to 7 preceding days. Potential confounders included the season and daily rainfall. Separate models were created for visits from people living in zip codes that used Lake Michigan drinking water and those who used other water sources.
Over the 3-year study period, there was a mean of 5.0 +/- 3.8 (SD) daily visits for diarrheal illness from people who lived in zip codes that used Lake Michigan drinking water and 1.2 +/- 1.4 (SD) from outside that area. There were 6 sewage-bypass events identified. After adjusting for the season and rainfall, there was a significant increase of 2.5 to 2.7 visits only from people who lived in zip codes that used Lake Michigan drinking water after the 2 largest of the 6 bypass events.
Emergency department visits for diarrheal illness increased significantly after 2 events of release of partially treated sewage into area waterways. These data suggest a potentially harmful effect of such practices.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization. We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity. Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001). We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.
    BMC Health Services Research 06/2010; 10:173. DOI:10.1186/1472-6963-10-173 · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Microbial water contamination after periods of heavy rainfall is well described, but its link to acute gastrointestinal illness (AGI) in children is not well known. We hypothesize an association between rainfall and pediatric emergency department (ED) visits for AGI that may represent an unrecognized, endemic burden of pediatric disease in a major U.S. metropolitan area served by municipal drinking water systems. We conducted a retrospective time series analysis of visits to the Children's Hospital of Wisconsin ED in Wauwatosa, Wisconsin. Daily visit totals of discharge International Classification of Diseases, 9th Revision codes of gastroenteritis or diarrhea were collected along with daily rainfall totals during the study period from 2002 to 2007. We used an autoregressive moving average model, adjusting for confounding variables such as sewage release events and season, to look for an association between daily visits and rainfall after a lag of 1-7 days. A total of 17,357 AGI visits were identified (mean daily total, 7.9; range, 0-56). Any rainfall 4 days prior was significantly associated with an 11% increase in AGI visits. Expected seasonal effects were also seen, with increased AGI visits in winter months. We observed a significant association between rainfall and pediatric ED visits for AGI, suggesting a waterborne component of disease transmission in this population. The observed increase in ED visits for AGI occurred in the absence of any disease outbreaks reported to public health officials in our region, suggesting that rainfall-associated illness may be underestimated. Further study is warranted to better address this association.
    Environmental Health Perspectives 10/2010; 118(10):1439-43. DOI:10.1289/ehp.0901671 · 7.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. This study investigated if the type of drinking water source (treated municipal, untreated municipal, and private well water) modifies the effect of hydrology on childhood (aged < 5 years) gastrointestinal illness. Methods. We conducted a time series study to assess the relationship between hydrologic and weather conditions with childhood gastrointestinal illness from 1991 to 2010. The Central and Northern Wisconsin study area includes households using all 3 types of drinking water systems. Separate time series models were created for each system and half-year period (winter/spring, summer/fall). Results. More precipitation (summer/fall) systematically increased childhood gastrointestinal illness in municipalities accessing untreated water. The relative risk of contracting gastrointestinal illness was 1.4 in weeks with 3 centimeters of precipitation and 2.4 in very wet weeks with 12 centimeters of precipitation. By contrast, gastrointestinal illness in private well and treated municipal areas was not influenced by hydrologic conditions, although warmer winter temperatures slightly increased incidence. Conclusions. Our study suggests that improved drinking water protection, treatment, and delivery infrastructure may improve public health by specifically identifying municipal water systems lacking water treatment that may transmit waterborne disease. (Am J Public Health. Published online ahead of print February 13, 2014: e1-e8. doi:10.2105/AJPH.2013.301659).
    American Journal of Public Health 02/2014; DOI:10.2105/AJPH.2013.301659 · 4.23 Impact Factor