Environmental and Occupational Health, Public Health Ontario, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Epidemiol Infect. 2020 Mar 13;148:e70. doi: 10.1017/S0950268820000631.
Burden of disease analyses can quantify the relative impact of different exposures on population health outcomes. Gastroenteritis where the causative pathogen was not determined and respiratory illness resulting from exposure to opportunistic pathogens transmitted by water aerosols have not always been considered in waterborne burden of disease estimates. We estimated the disease burden attributable to nine enteric pathogens, unspecified pathogens leading to gastroenteritis, and three opportunistic pathogens leading primarily to respiratory illness, in Ontario, Canada (population ~14 million). Employing a burden of disease framework, we attributed a fraction of annual (year 2016) emergency department (ED) visits, hospitalisations and deaths to waterborne transmission. Attributable fractions were developed from the literature and clinical input, and unattributed disease counts were obtained using administrative data. Our Monte Carlo simulation reflected uncertainty in the inputs. The estimated mean annual attributable rates for waterborne diseases were (per 100 000 population): 69 ED visits, 12 hospitalisations and 0.52 deaths. The corresponding 5th-95th percentile estimates were (per 100 000 population): 13-158 ED visits, 5-22 hospitalisations and 0.29-0.83 deaths. The burden of disease due to unspecified pathogens dominated these rates: 99% for ED visits, 63% for hospitalisations and 40% for deaths. However, when a causative pathogen was specified, the majority of hospitalisations (83%) and deaths (97%) resulted from exposure to the opportunistic pathogens Legionella spp., non-tuberculous mycobacteria and Pseudomonas spp. The waterborne disease burden in Ontario indicates the importance of gastroenteritis not traced back to a particular pathogen and of opportunistic pathogens transmitted primarily through contact with water aerosols.
疾病负担分析可以定量评估不同暴露因素对人群健康结果的相对影响。在水中疾病负担估计中，尚未始终考虑到病因未明的肠胃炎和由水气溶胶传播的机会性病原体引起的呼吸道疾病。我们在加拿大安大略省（人口约 1400 万）估计了 9 种肠道病原体、病因未明的肠胃炎病原体和 3 种主要导致呼吸道疾病的机会性病原体引起的疾病负担。我们采用疾病负担框架，将一部分年度（2016 年）急诊就诊、住院和死亡归因于经水传播。归因分数是根据文献和临床输入制定的，未归因的疾病计数是使用行政数据获得的。我们的蒙特卡罗模拟反映了输入的不确定性。经水传播疾病的估计年平均归因率为（每 10 万人）：69 次急诊就诊、12 次住院和 0.52 人死亡。相应的 5 分位数-95 分位数估计值为（每 10 万人）：13-158 次急诊就诊、5-22 次住院和 0.29-0.83 人死亡。病因未明病原体引起的疾病负担占这些比率的 99%：急诊就诊占 63%，住院占 40%，死亡占 40%。但是，当指定了病原体时，大多数住院（83%）和死亡（97%）是由接触水气溶胶传播的机会性病原体军团菌属、非结核分枝杆菌和铜绿假单胞菌引起的。安大略省的水中疾病负担表明，病因未明的肠胃炎和主要通过接触水气溶胶传播的机会性病原体的重要性。
