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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
Citation:
Jagai, J., Q. Li, K. Messier, S. Wang, Tim Wade, AND E Hilborn. Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas With and Without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003-2007. ENVIRONMENTAL HEALTH PERSPECTIVES. National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, 123(9):873-9, (2015).
Impact/Purpose:
Water quality can be impacted by water infrastructure. In this report, we examine the association of gastrointestinal illness after extreme rainfall events and the presence of combined sewer overflows among 3 groups of towns in Massachusetts. We find that CSOs discharging into drinking water sources are associated with modest but measurable increases in gastrointestinal illness after extreme rainfall events. This information is useful for understanding the potential impacts of water infrastructure on human health as we experience more extreme rainfall events as is forecast to occur during climate change. This work supports products for SSWR 2.2B1 and crosslists to ACE 121
Description:
Background: Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff discharge into waterbodies potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation events associated with climate change. Objectives: The aim of this study was to assess whether the association between extreme rainfall and emergency room (ER) visits for gastrointestinal (GI) illness differed by the presence of CSOs.Methods: For the study period 2003 - 2007, time series of daily rate of ER visits for GI and meteorological data were organized for three exposure regions: 1) CSOs impacting drinking water sources; 2) CSOs impacting recreational waters; 3) 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 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.
