DeFlorio-Barker Stephanie, Wade Timothy J, Turyk Mary, Dorevitch Samuel
Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Illinois, USA E-mail:
National Health and Environmental Effects Research Laboratory, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA.
J Water Health. 2016 Oct;14(5):713-726. doi: 10.2166/wh.2016.002.
The health endpoint of prior studies of water recreation has been the occurrence of gastrointestinal (GI) illness. This dichotomous measure fails to take into account the range of symptom severity among those with GI illness, and those who develop GI symptoms but who do not satisfy the definition of GI illness. Data from two US cohort studies were used to assess use of ordinal and semi-continuous measures of GI symptoms, such as duration of GI symptoms and responses to those symptoms such as medication use, interference with daily activities, and utilization of healthcare service. Zero-inflated negative binomial and logistic regression models were used to assess associations between severity and either the degree of water exposure or water quality. Among 37,404 water recreators without baseline GI symptoms, we observed individuals with relatively low severity satisfying the case definition of GI illness, while others with high severity not satisfying that definition. Severity metrics were associated with water exposure. The dichotomous GI illness outcome could be improved by considering symptom severity in future studies. Modeling ordinal and semi-continuous outcomes may improve our understanding of determinants of the burden of illness rather than simply the number of cases of illness attributable to environmental exposures.
先前关于水上娱乐活动的研究的健康终点是胃肠道（GI）疾病的发生。这种二分法测量未能考虑到患有胃肠道疾病的人群中症状严重程度的范围，以及那些出现胃肠道症状但不符合胃肠道疾病定义的人群。来自两项美国队列研究的数据被用于评估胃肠道症状的有序和半连续测量方法的使用情况，例如胃肠道症状的持续时间以及对这些症状的反应，如药物使用、对日常活动的干扰以及医疗服务的利用情况。零膨胀负二项式和逻辑回归模型被用于评估严重程度与水暴露程度或水质之间的关联。在37404名无基线胃肠道症状的水上娱乐者中，我们观察到症状相对较轻的个体符合胃肠道疾病的病例定义，而其他症状严重的个体则不符合该定义。严重程度指标与水暴露有关。在未来的研究中考虑症状严重程度可能会改善二分法的胃肠道疾病结果。对有序和半连续结果进行建模可能会增进我们对疾病负担决定因素的理解，而不仅仅是归因于环境暴露的疾病病例数。
