Dataset Information

Watershed integrity and associations with gastrointestinal illness in the United States.

ABSTRACT: Gastrointestinal (GI) illnesses are associated with various environmental factors, such as water quality, stormwater runoff, agricultural runoff, sewer overflows, and wastewater treatment plant effluents. However, rather than assessing an individual factor alone, two indices incorporating a combination of ecological and environmental stressors were created to represent (1) overall watershed integrity, Index of Watershed Integrity (IWI) and (2) catchment integrity, Index of Catchment Integrity (ICI). These indices could provide a more comprehensive understanding of how watershed/catchment integrity potentially impact the rates of GI illness, compared to assessing an individual stressor alone. We utilized the IWI and ICI, as well as agricultural and urban land uses, to assess associations at the county level with the rates of GI illness in a population of adults over 65 years of age. Our findings demonstrated that both watershed and catchment integrity are associated with reduced hospitalizations for any GI outcomes, though association varied by urbanicity. We believe that improved versions of the IWI and ICI may potentially be useful indicators for public health analyses in other circumstances, particularly when considering rural areas or to capture the complex stressors impacting the ecological health of a watershed.

SUBMITTER: Jagai JS

PROVIDER: S-EPMC10439500 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Watershed integrity and associations with gastrointestinal illness in the United States.

Jagai Jyotsna S JS Krajewski Alison K AK Jimenez Monica P MP Murphy Mark S MS Leibowitz Scott G SG Lobdell Danelle T DT

Journal of water and health 20191201 6

Gastrointestinal (GI) illnesses are associated with various environmental factors, such as water quality, stormwater runoff, agricultural runoff, sewer overflows, and wastewater treatment plant effluents. However, rather than assessing an individual factor alone, two indices incorporating a combination of ecological and environmental stressors were created to represent (1) overall watershed integrity, Index of Watershed Integrity (IWI) and (2) catchment integrity, Index of Catchment Integrity (I ...[more]

PMID: 31850904

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Project description:Watershed integrity is the capacity of a watershed to support and maintain the full range of ecological processes and functions essential to sustainability. Using information from EPA's StreamCat dataset, we calculated and mapped an Index of Watershed Integrity (IWI) for 2.6 million watersheds in the conterminous US with first-order approximations of relationships between stressors and six watershed functions: hydrologic regulation, regulation of water chemistry, sediment regulation, hydrologic connectivity, temperature regulation, and habitat provision. Results show high integrity in the western US, intermediate integrity in the southern and eastern US, and the lowest integrity in the temperate plains and lower Mississippi Valley. Correlation between the six functional components was high (r = 0.85-0.98). A related Index of Catchment Integrity (ICI) was developed using local drainages of individual stream segments (i.e., excluding upstream information). We evaluated the ability of the IWI and ICI to predict six continuous site-level indicators with regression analyses - three biological indicators and principal components derived from water quality, habitat, and combined water quality and habitat variables - using data from EPA's National Rivers and Streams Assessment. Relationships were highly significant, but the IWI only accounted for 1-12% of the variation in the four biological and habitat variables. The IWI accounted for over 25% of the variation in the water quality and combined principal components nationally, and 32-39% in the Northern and Southern Appalachians. We also used multinomial logistic regression to compare the IWI with the categorical forms of the three biological indicators. Results were consistent: we found positive associations but modest results. We compared how the IWI and ICI predicted the water quality PC relative to agricultural and urban land use. The IWI or ICI are the best predictors of the water quality PC for the CONUS and six of the nine ecoregions, but they only perform marginally better than agriculture in most instances. However, results suggest that agriculture would not be appropriate in all parts of the country, and the index is meant to be responsive to all stressors. The IWI in its present form (available through the StreamCat website; https://www.epa.gov/national-aquatic-resource-surveys/streamcat) could be useful for management efforts at multiple scales, especially when combined with information on site condition. The IWI could be improved by incorporating empirical or literature-derived relationships between functional components and stressors. However, limitations concerning the absence of data for certain stressors should be considered.

Project description:BackgroundNational social determinant of health (SDoH) studies on gastrointestinal cancers (GIC) have observed single GIC-types for surgery but not across all GIC-types, non-surgical treatments outcomes, or mortality. The Social Vulnerability Index (SVI), a validated large-data SDoH-tool, quantifiably characterizes the interrelatedness of SDoH-impact through dynamic, region-contextualized measures.MethodsThis retrospective cohort study assessed GIC patients (20+ years) between 2013 and 2017 from the Surveillance, Epidemiology, and End Results (SEER) database for total and subcomponent social vulnerability associations across 15 SDoH-variables encompassing themes of socioeconomic status, minority-language status, household composition, and housing-transportation measured by the Social Vulnerability Index (SVI). These are measured and contextualized from all US counties. Univariate logistic and linear regressions of these vulnerability associations with treatment receipt (chemotherapy, radiation, primary surgery) and survival were performed for the entire cohort and across race/ethnicity strata.ResultsWith increasing overall social vulnerability, 287,248 patients (162,387 [56.5%] male; 185,250 [64.6%] white) demonstrated decreased receipt of chemotherapy (lowest, pancreas-OR, 0.90; 95% CI, 0.88-0.93), radiotherapy (hepatic-OR, 0.87; 95% CI, 0.85-0.89) and surgery (esophagus-OR, 0.90; 95% CI, 0.87-0.92) for 13/14, 10/14, and 8/14 GIC-types, respectively. Survival period decreases upwards of 21.3% (biliary tract: 6.9-5.4 months) were observed across 7/14 GICs. Treatment receipt and survival decreases were exacerbated for non-White patients for 9/14 GICs. Socioeconomic status, minority-language, household composition, and housing-transportation vulnerabilities differentially contributed to these trends.DiscussionSocial vulnerability was associated with worse prognostic and treatment disparities, with certain SDoH-types differentially contributing to these detrimental trends per GIC-type while associations were exacerbated among non-White race/ethnic patients. These real-world contexts present actionable targets for further initiatives to combat GIC disparities.

Project description:ObjectivesThe epidemiology of chronic critical illness is not well characterized. We sought to determine the prevalence, outcomes, and associated costs of chronic critical illness in the United States.DesignPopulation-based cohort study using data from the United States Healthcare Costs and Utilization Project from 2004 to 2009.SettingAcute care hospitals in Massachusetts, North Carolina, Nebraska, New York, and Washington.PatientsAdult and pediatric patients meeting a consensus-derived definition for chronic critical illness, which included one of six eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis, or severe wounds) plus at least 8 days in an ICU.InterventionsNone.Measurements and main resultsOut of 3,235,741 admissions to an ICU during the study period, 246,151 (7.6%) met the consensus definition for chronic critical illness. The most common eligibility conditions were prolonged acute mechanical ventilation (72.0% of eligible admissions) and sepsis (63.7% of eligible admissions). Among patients meeting chronic critical illness criteria through sepsis, the infections were community acquired in 48.5% and hospital acquired in 51.5%. In-hospital mortality was 30.9% with little change over the study period. The overall population-based prevalence was 34.4 per 100,000. The prevalence varied substantially with age, peaking at 82.1 per 100,000 individuals 75-79 years old but then declining coincident with a rise in mortality before day 8 in otherwise eligible patients. Extrapolating to the entire United States, for 2009, we estimated a total of 380,001 cases; 107,880 in-hospital deaths and $26 billion in hospital-related costs.ConclusionsUsing a consensus-based definition, the prevalence, hospital mortality, and costs of chronic critical illness are substantial. Chronic critical illness is particularly common in the elderly although in very old patients the prevalence declines, in part because of an increase in early mortality among potentially eligible patients.

Dataset Information

Watershed integrity and associations with gastrointestinal illness in the United States.

Publications

Watershed integrity and associations with gastrointestinal illness in the United States.

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