Background

Communities in rural Alaska have access to multiple types of water service (piped, vehicle-hauled, and self-hauled) and experience varying levels of water service coverage. We assessed the incidence rate of inpatient and outpatient infectious disease visits among communities with different water service types and coverage levels.

Methods

We classified ICD-9 codes for inpatient and outpatient visits to the Yukon-Kuskokwim Health Corporation facilities between 2013 and 2015 into six infectious disease categories. Using Poisson models, we compared the incidence of visits in each category across communities with differing water service coverage levels as defined by water service billing data for the same years. Using census data, we adjusted for community median household income, median age, crowding, and health aide staffing.

Results

We included 48 communities in this analysis. After adjusting for possible confounders, each 10% increase in piped water coverage was associated with a 4% lower incidence of pneumonia/influenza visits (adjusted incidence rate ratio [IRR] 0.96, 95% CI 0.93–0.98), a 2% lower incidence of other respiratory infection visits (adjusted IRR 0.98, 95% CI 0.97–0.99), an 8% lower incidence of methicillin-resistant Staphylococcus visits (adjusted IRR 0.92, 95% CI 0.87–0.97), and a 4% lower incidence of other skin infections visits (adjusted IRR 0.96, 95% CI 0.95–0.98). Each 10% increase in vehicle-hauled water coverage was associated with a 2% lower incidence of respiratory infection visits (adjusted IRR 0.98, 95% CI 0.97–0.996) and a 3% lower incidence of skin infection visits (adjusted IRR 0.97, 95% CI 0.95–0.99), also after adjustment.

Conclusions

Higher levels of water service coverage were associated with lower incidence rates of visits for several infectious disease categories. These associations were more pronounced for communities with piped water service compared to vehicle-hauled water service.

中文翻译：

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2013-2015年，阿拉斯加农村地区的社区供水和呼吸，皮肤和胃肠道感染的发生率。

背景

阿拉斯加农村地区的社区可以使用多种类型的供水服务（管道，车辆牵引和自牵引），并且可以体验到不同水平的供水服务。我们评估了不同水服务类型和覆盖水平的社区中住院和门诊传染病就诊的发生率。

方法

我们将2013年至2015年间育空地区-库斯科维姆卫生公司设施的住院和门诊患者的ICD-9编码分为六类传染病。使用Poisson模型，我们比较了同一年份水务收费数据所定义的，水务覆盖水平不同的社区中每个类别的访问发生率。使用人口普查数据，我们对社区中位数家庭收入，中位数年龄，拥挤程度和医疗助手人员进行了调整。

结果

在此分析中，我们纳入了48个社区。在对可能的混杂因素进行调整之后，自来水覆盖率每增加10％，肺炎/流感就诊的发生率就会降低4％（调整后的发生率[IRR] 0.96，95％CI 0.93-0.98），发生率降低2％的其他呼吸道感染访视（调整后的IRR 0.98，95％CI 0.97-0.99），耐甲氧西林的葡萄球菌的发生率降低8％访视（调整后的IRR 0.92，95％CI 0.87-0.97），其他皮肤感染访视的发生率降低4％（调整后的IRR 0.96，95％CI 0.95-0.98）。车辆运输水覆盖率每增加10％，呼吸道感染就诊率降低2％（IRR调整后为0.98，95％CI为0.97-0.996），皮肤感染就诊率降低3％（经过调整的IRR为0.97、95 ％CI 0.95–0.99），也经过调整。

结论

较高的水服务覆盖率与几种传染病类别的较低就诊率相关。与使用管道运输的水服务相比，这些联系对于使用自来水服务的社区更为明显。