Water, Health and Applied Microbiology (WHAM) Lab, Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, United States; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States.
Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, United States.
Water Res. 2023 Aug 15;242:120244. doi: 10.1016/j.watres.2023.120244. Epub 2023 Jun 17.
The vast majority of residents of high-income countries (≥90%) reportedly have high access to safely managed drinking water. Owing perhaps to the widely held perception of near universal access to high-quality water services in these countries, the burden of waterborne disease in these contexts is understudied. This systematic review aimed to: identify population-scale estimates of waterborne disease in countries with high access to safely managed drinking water, compare methods to quantify disease burden, and identify gaps in available burden estimates. We conducted a systematic review of population-scale disease burden estimates attributed to drinking water in countries where ≥90% of the population has access to safely managed drinking water per official United Nations monitoring. We identified 24 studies reporting estimates for disease burden attributable to microbial contaminants. Across these studies, the median burden of gastrointestinal illness risks attributed to drinking water was ∼2,720 annual cases per 100,000 population. Beyond exposure to infectious agents, we identified 10 studies reporting disease burden-predominantly, cancer risks-associated with chemical contaminants. Across these studies, the median excess cancer cases attributable to drinking water was 1.2 annual cancer cases per 100,000 population. These median estimates slightly exceed WHO-recommended normative targets for disease burden attributable to drinking water and these results highlight that there remains important preventable disease burden in these contexts, particularly among marginalized populations. However, the available literature was scant and limited in geographic scope, disease outcomes, range of microbial and chemical contaminants, and inclusion of subpopulations (rural, low-income communities; Indigenous or Aboriginal peoples; and populations marginalized due to discrimination by race, ethnicity, or socioeconomic status) that could most benefit from water infrastructure investments. Studies quantifying drinking water-associated disease burden in countries with reportedly high access to safe drinking water, focusing on specific subpopulations lacking access to safe water supplies and promoting environmental justice, are needed.
据报道，高收入国家（≥90%）的绝大多数居民都能方便地获得安全管理的饮用水。由于这些国家的人们普遍认为能够获得高质量的水服务，因此这些国家的水源性疾病负担研究相对较少。本系统评价旨在：确定高收入国家（≥90%的人口可获得安全管理饮用水）中与饮用水相关的疾病负担的人群规模估计值，比较量化疾病负担的方法，并确定现有负担估计值中的差距。我们对≥90%的人口可获得安全管理饮用水的国家进行了系统评价，评估与饮用水相关的人群规模疾病负担。我们确定了 24 项研究报告了与微生物污染物相关的疾病负担估计值。在这些研究中，归因于饮用水的胃肠道疾病风险的中位数负担约为每 10 万人中有 2720 例。除了接触感染源外，我们还确定了 10 项研究报告了与化学污染物相关的疾病负担，主要是癌症风险。在这些研究中，归因于饮用水的超额癌症病例中位数为每 10 万人中有 1.2 例癌症病例。这些中位数估计值略高于世界卫生组织推荐的与饮用水相关的疾病负担规范目标，这些结果表明，在这些情况下仍存在重要的可预防疾病负担，特别是在边缘化人群中。然而，现有文献稀缺且地理范围有限，疾病结局、微生物和化学污染物的范围以及包括（农村、低收入社区；土著或原住民；以及因种族、族裔或社会经济地位而受到歧视而处于边缘地位的人群）等方面受到限制，这些人群最需要从水基础设施投资中受益。需要在据称可方便获得安全饮用水的国家中开展研究，量化与饮用水相关的疾病负担，重点关注缺乏安全供水的特定亚人群，并促进环境公正。
