Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act
- PDF / 3,176,696 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 13 Downloads / 203 Views
O R I G I N A L PA P E R
Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act Jyotsna S. Jagai · Barbara J. Rosenbaum · Suzanne M. Pierson · Lynne C. Messer · Kristen Rappazzo · Elena N. Naumova · Danelle T. Lobdell
Received: 21 December 2012 / Revised: 4 June 2013 / Accepted: 6 June 2013 © Springer Science+Business Media Dordrecht (outside the USA) 2013
Abstract Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixedeffects models were used to assess county-level associaJ.S. Jagai () · D.T. Lobdell National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, MD 58A, Research Triangle Park, NC, USA e-mail: [email protected] D.T. Lobdell () e-mail: [email protected] B.J. Rosenbaum · S.M. Pierson Innovate!, Inc., Alexandria, VA, USA L.C. Messer Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA K. Rappazzo Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA E.N. Naumova Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
tions between percent impaired waters and hospitalization rates adjusted for population density, a proxy for personto-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses. Keywords Clean water act · Drinking water · Recreational water · Gastrointestinal infection · Mixed effects model
Background It is estimated that in the US approximately 16.4 million cases of acute gastrointestinal illness per year are attributable to drinking water contamination (Messner et al. 2006). The sources of most waterb
Data Loading...
