EPA Science Inventory

Hospital visits for gastrointestinal Illness after a major water main break in 2010

Citation:

Lin, C., Tim Wade, E Hilborn, H. Weinberg, L. Engel, AND D. Richardson. Hospital visits for gastrointestinal Illness after a major water main break in 2010. International Society of Environmental Epidemiology (ISEE) Conference, Sydney, New South Wales, AUSTRALIA, September 24 - 28, 2017.

Description:

Background/Aim Water main breaks can occur due to the stresses of an aging infrastructure and changing climate. Water main breaks are a public health concern because they can cause pressure transients (specifically, abrupt decreases in water pressure/flow in the pipeline), which can lead to the intrusion of contaminants. In May 2010, a major water main break affected approximately 2 million residents in 30 Greater Boston communities and a boil order was issued. This study examines the association between the main break and subsequent hospital visits for gastrointestinal illness. Methods A case-crossover study was used to assess emergency room (ER) and hospital outpatient visits for gastrointestinal (GI) illness following the main break in 2010. ER and hospital outpatient data were obtained from the State of Massachusetts. GI illness was defined using ICD-9-CM diagnosis codes. Main break details were obtained from archived press releases. Controls were selected using a time-stratified bi-directional approach and matched on day of week. Exposure status was determined according to when and where the case/control occurred relative to the main break. Fixed-effects logistic regression models estimated risk of hospital visit during the 0-3 and 4-7 days following the main break. Results In 2010, there were 46,420 ER and hospital outpatient visits for GI illness in Massachusetts. Main break exposure was positively associated with ER and hospital outpatient visits during the first 0-3 days (Odds Ratio, OR: 1.47; 95% Confidence Interval, CI: 1.14-1.89) and subsequent 4-7 days (OR: 1.58; 95% CI: 1.20-2.07). These associations were particularly strong among young children (≤5 years). Conclusions A major main break in 2010 was associated with an increased risk for ER and hospital outpatient visits for GI illness. Future analyses will examine less severe main breaks over time and assign exposure based on service zone. This abstract does not necessarily reflect EPA policy.

Purpose/Objective:

Water main breaks are becoming increasing common in the US as our drinking water distribution systems age and soils shift in response to droughts and floods. Main breaks are an emergency as they disrupt normal operations and have potential health consequences due to contamination of drinking water supplies. In 2010, a major water main broke in Eastern Massachusetts, a boil water advisory was issued. We report a significant association between emergency room and outpatient hospital visits for gastrointestinal illnesses within 7 days of the main break among residents of affected towns. This association was stronger among children less than 5 years of age. This report is categorized as a product of SSWR 3.02A and ACE CIVA 1.7.

Record Details:

Record Type: DOCUMENT (PRESENTATION/SLIDE)
Completion Date: 09/26/2017
Record Last Revised: 10/17/2017
Record Created: 10/17/2017
Record Released: 10/17/2017
OMB Category: Other
Record ID: 337907

Organization:

U.S. ENVIRONMENTAL PROTECTION AGENCY

OFFICE OF RESEARCH AND DEVELOPMENT

NATIONAL HEALTH AND ENVIRONMENTAL EFFECTS RESEARCH LABORATORY

ENVIRONMENTAL PUBLIC HEALTH DIVISION

EPIDEMIOLOGY BRANCH