An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application
An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application
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DOI：
10.2166/wh.2006.024
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发表时间：
2006-01-01
影响因子：
2.3
通讯作者：
Soller, Jeff
中科院分区：
文献类型：
--
作者：
Messner, Michael;Shaw, Susan;Soller, Jeff
本文介绍了美国环境保护署（EPA）利用流行病学研究的信息，对与饮用水有关的地方性急性胃肠道疾病（AGI）进行的全国性评估。在美国，只有数量有限的流行病学研究测量了水传播疾病的发生率。对于这项分析，我们假设，某些未知的AGI发病率在每个公共饮用水系统是由于饮用水和统计分布的不同发病率的人口服务的每个系统可以估计，告知平均全国估计AGI疾病由于饮用水。来自公共供水系统的数据表明，由于饮用水引起的AGI的发生率可能相差几个数量级。此外，来自流行病学研究的数据显示，由于饮用水引起的AGI发病率从基本上没有（或低于研究检测水平）到每人每年0.26例不等。综合考虑这两个方面以及相关的不确定性，EPA开发了一种分析方法和模型，用于生成每年因饮用水引起的AGI疾病的全国估计值。美国环保署制定了一项全国性的水传播疾病估计，部分是为了解决1996年《安全饮用水法修正案》。国家估计数使用了现有最佳科学，但也认识到支持某些模型假设的数据存在差距，以及估计数存在不确定性。根据所提出的模型，EPA估计每年可归因于饮用水的AGI平均发病率为0.06例（95%可信区间为0.02-0.12）。平均估计值代表了社区供水系统服务的人口中所有原因引起的AGI疾病病例的约8.5%。在同一人群中，估计发病率为1 640万例/年。该估计说明了该方法的潜在用途和挑战，并为数据需求和未来研究设计的讨论提供了重点。在估计分析的范围内讨论了目前限制该方法有用性的主要不确定性领域。
in this paper, the US Environmental Protection Agency (EPA) presents an approach and a national estimate of drinking water related endemic acute gastrointestinal illness (AGI) that uses information from epidemiologic studies. There have been a limited number of epidemiologic studies that have measured waterborne disease occurrence in the United States. For this analysis, we assume that certain unknown incidence of AGI in each public drinking water system is due to drinking water and that a statistical distribution of the different incidence rates for the population served by each system can be estimated to inform a mean national estimate of AGI illness due to drinking water. Data from public water systems suggest that the incidence rate of AGI due to drinking water may vary by several orders of magnitude. in addition, data from epidemiologic studies show AGI incidence due to drinking water ranging from essentially none (or less than the study detection level) to a rate of 0.26 cases per person-year. Considering these two perspectives collectively, and associated uncertainties, EPA has developed an analytical approach and model for generating a national estimate of annual AGI illness due to drinking water. EPA developed a national estimate of waterborne disease to address, in part, the 1996 Safe Drinking Water Act Amendments. The national estimate uses best available science, but also recognizes gaps in the data to support some of the model assumptions and uncertainties in the estimate. Based on the model presented, EPA estimates a mean incidence of AGI attributable to drinking water of 0.06 cases per year (with a 95% credible interval of 0.02-0.12). The mean estimate represents approximately 8.5% of cases of AGI illness due to all causes among the population served by community water systems. The estimated incidence translates to 16.4 million cases/year among the same population. The estimate illustrates the potential usefulness and challenges of the approach, and provides a focus for discussions of data needs and future study designs. Areas of major uncertainty that currently limit the usefulness of the approach are discussed in the context of the estimate analysis.