Assessing the Link between Water System Violations and Public Health Outcomes

Abstract Submission: Ensuring safe drinking water remains a critical concern in the US, where many community water systems (CWSs) frequently fail to meet drinking water standards, raising significant concerns about water safety and contributing to waterborne illnesses. Despite extensive research on health-based (HB) violations as indicators of waterborne diseases, there is a lack of studies directly linking HB violations to health incidences. This study addresses this gap by examining the association between HB and non-health-based (NHB) violations in CWS and emergency department visits (EDVs) for waterborne gastrointestinal diseases across Texas from 2016 to 2022. This study uses Poisson regression to evaluate these associations while adjusting for CWS features, such as size, ownership, population served, and social indicators, such as the Social Vulnerability Index and urban population percentage. Key challenges include reconciling diverse datasets across different spatial levels and managing outliers. Initial results suggest that contrary to the expectation, HB and NHB violations are negatively associated with EDV rates; however these have significantly less contribution compared to other covariates. As expected, publicly owned CWS with surface water sources are positively associated with increased EDV rates. Key complications of the analysis are that existing measures of HB and NHB violations may not accurately reflect the health risks associated with drinking water, and EDV counts may not fully capture the incidence of waterborne gastrointestinal diseases. Further research is needed to explore these limitations and improve data adequacy. As the first study to directly link water violations to public health outcomes, these findings offer new insights that could help policymakers design more effective interventions, particularly for smaller systems where violations are more prevalent.

Learning Objectives/Expected Outcome (Optional) :