The association between E. coli exceedances in drinking water supplies and healthcare utilisation of older people.

Evidence concerning the effects of indicators of waterborne pathogens on healthcare systems is of importance for policymaking, future infrastructure considerations and healthcare planning. This paper examines the association between the detection of E. coli in water tests associated with drinking water supplies and the use of healthcare services by older people in Ireland. Uniquely, three sources of data are linked to conduct the analysis. Administrative records of E. coli exceedances recorded from routine water quality tests carried out by Ireland's Environmental Protection Agency are first linked to maps of water systems infrastructure in Ireland. Then, residential addresses of participants of The Irish Longitudinal Study of Ageing (TILDA), a nationally representative survey of over 50-year-olds in Ireland, are linked to the water systems dataset which has the associated water quality monitoring information. Multivariate regression analysis estimates a greater incident rate ratio (IRR) of General Practitioner (GP) visits in the previous year where E. coli is detected in the water supply associated with an older person's residence (Incidence Rate Ratio (IRR) 1.118; [95% Confidence interval (CI): 1.019-1.227]), controlling for demographic and socio-economic factors, health insurance coverage, health, and health behaviours. Where E. coli is detected in water, a higher IRR is also estimated for visits to an Emergency Department (IRR: 1.292; [95% CI: 0.995-1.679]) and nights spent in hospital (IRR: 1.351 [95% CI: 1.004-1.818]).