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Emergency department visits for acute gastrointestinal illness after a major water pipe break in 2010

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

doi: 10.1097/EDE.0000000000001083
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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, Massachusetts, 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 two weeks before and after each case. We estimated the risk of visiting the emergency department during the 0–3 and 4–7 days following 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 through 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 to referent dates selected two 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 4–7 day association was elevated (OR= 1.4; 95% CI: 1.1-1.8).

Conclusion: 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.

UNC Gillings School of Global Public Health

UNC Gillings School of Global Public Health

US EPA, Environmental Public Health Division

UNC Gillings School of Global Public Health

UNC Gillings School of Global Public Health

US EPA, Environmental Public Health Division

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

Sources of financial support: US Environmental Protection Agency

Description of conflicts of interest: All authors declare no competing interests.

Acknowledgements: The authors would like to acknowledge Mr. John Sullivan from the Boston Water and Sewer Commission for sharing details about the water pipe break, Mr. Philip McDaniel for providing GIS support, and Dr. Tom Luben for his careful review and suggestions to improve the draft manuscript.

Disclaimer: 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.

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

Corresponding author and contact information: Cynthia J. Lin, 635 Meridian Parkway, Suite 200, Durham, NC 27713, 919-695-3815, cjlin@alumni.unc.edu

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