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Emergency Department Visits for Acute Gastrointestinal Illness After a Major Water Pipe Break in 2010

Lin, Cynthia J.a; Richardson, David B.a; Hilborn, Elizabeth D.b; Weinberg, Howarda; Engel, Larry S.a; Wade, Timothy J.b

doi: 10.1097/EDE.0000000000001083
Infectious Diseases

Background: When a water pipe breaks, contaminants can enter the drinking water system and cause waterborne illnesses such as acute gastrointestinal illness. In May 2010, a major water pipe broke near Boston, MA, and a boil water order was issued to nearly two million residents.

Methods: Using a case-crossover study design, we examined the association between the water pipe break and subsequent emergency department visits for acute gastrointestinal illness. We identified cases of illness according to ICD-9-CM diagnosis codes and selected control dates 2 weeks before and after each case. We estimated the risk of visiting the emergency department during the 0–3 and 4–7 days after the water pipe break using conditional logistic regression models.

Results: Our analysis included 5,726 emergency department visits for acute gastrointestinal illness from 3 April 2010 to 5 June 2010. Overall, there was a 1.3-fold increased odds for visiting the emergency department for acute gastrointestinal illness during the 0–3 days after the water pipe break (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) compared with referent dates selected 2 weeks before and after. During the 4–7 days after the break, the association diminished overall (OR = 1.1; 95% CI = 0.96, 1.2). However, in communities over 12 miles from the break, the 4- to 7-day association was elevated (OR = 1.4; 95% CI = 1.1, 1.8).

Conclusions: This study suggests that a major water pipe break was associated with emergency department visits for acute gastrointestinal illness, particularly during the 0–3 days after the break, when a boil water order was in effect.

From the aUNC Gillings School of Global Public Health, Chapel Hill, NC

bUS EPA, Environmental Public Health Division, Chapel Hill, NC.

Submitted August 8, 2018; accepted July 28, 2019.

Financially supported by the US Environmental Protection Agency

The authors report no conflicts of interest.

The views expressed in this manuscript are those of the individual authors and do not necessarily reflect the views and policies of the U.S. Environmental Protection Agency. Mention of trade names or commercial products does not constitute endorsement or recommendation for use.

Cynthia J. Lin completed this work at UNC Gillings School of Global Public Health but is now a Senior Health Scientist at ICF.

Code is available on request, and data are available from the Commonwealth of Massachusetts Center for Health Information and Analysis.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Cynthia J. Lin, ICF, 635 Meridian Parkway, Suite 200, Durham, NC 27713. E-mail:

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