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Water Recreation and Illness Severity
Citation:
DeFlorio-Baker, S., Tim Wade, M. Turyk, AND S. Dorevitch. Water Recreation and Illness Severity. JOURNAL OF WATER AND HEALTH. IWA Publishing, London, Uk, 14(5):713-726, (2016).
Impact/Purpose:
In this study, various measures of severity for swimming associated gastroenteritis are compared. Potentially more meaningful metrics and measures of illness are developed compared to standard definitions of gastroenteritis
Description:
Abstract Background: The health endpoint of prior studies of water recreation has been the occurrence gastrointestinal (GI) of illness. The use of this dichotomous health outcome fails to take into account the range of symptom severity among those with GI illness, as well as those who develop GI symptoms but who do not satisfy the definition of GI illness. Methods: Data from two large cohort studies in the US were used to assess the use of ordinal and semi-continuous measures of GI symptoms, such as the duration of GI symptoms and responses to those symptoms such as medication use, interference of symptoms with daily activities, and utilization of health care service. Zero-inflated negative binomial and logistic regression models were used to assess associations between severity and either the degree of water exposure or water quality. Results: Among 37,404 water recreators without baseline GI symptoms, we observed individuals with relatively low severity that satisfied the case definition of GI illness while others with high severity did not satisfy that definition. Severity metrics were associated with water exposure, and, among swimmers, with a rapid molecular test of water quality. Conclusions: The dichotomous definition of GI illness outcome could be improved by considering symptom severity in future studies. Modeling ordinal and semi-continuous outcomes may improve our understanding of determinants of the burden of illness rather than simply the number of cases of illness attributable to environmental exposures.
