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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.115618v1 AJPH.2007.115618v2 98/11/2072    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Hennessy, T. W. Articles by Smith, J. Search for Related Content PubMed PubMed Citation Articles by Hennessy, T. W. Articles by Smith, J. Related Collections Epidemiology Other Infections Other Child and Adolescent Health Native Americans Rural Health Socioeconomic Factors Influenza

Thomas W. Hennessy, MD, MPH, Troy Ritter, REHS, MPH, Robert C. Holman, MS, Dana L. Bruden, MS, Krista L. Yorita, MPH, Lisa Bulkow, MS, James E. Cheek, MD, MPH, Rosalyn J. Singleton, MD, MPH and Jeff Smith, MS, RS

Thomas W. Hennessy, Dana L. Bruden, Lisa Bulkow, and Rosalyn J. Singleton are with the Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, AK. Troy Ritter and Jeff Smith are with the Division of Environmental Health and Engineering, Alaska Native Tribal Health Consortium, Anchorage. Robert C. Holman and Krista L. Yorita are with the Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA. James E. Cheek is with the National Epidemiology Program, Indian Health Service, Albuquerque, NM.

Correspondence: Requests for reprints should be sent to Thomas Hennessy, 4055 Tudor Centre Dr, Anchorage, AK 99508 (e-mail: thennessy{at}cdc.gov).

Objectives. We investigated the relationship between the presence of in-home piped water and wastewater services and hospitalization rates for respiratory tract, skin, and gastrointestinal tract infections in rural Alaska.

Methods. We determined in-home water service and hospitalizations for selected infectious diseases among Alaska Natives by region during 2000 to 2004. Within 1 region, infant respiratory hospitalizations and skin infections for all ages were compared by village-level water services.

Results. Regions with a lower proportion of home water service had significantly higher hospitalization rates for pneumonia and influenza (rate ratio [RR] = 2.5), skin or soft tissue infection (RR = 1.9), and respiratory syncytial virus (RR = 3.4 among those younger than 5 years) than did higher-service regions. Within 1 region, infants from villages with less than 10% of homes served had higher hospitalization rates for pneumonia (RR = 1.3) and respiratory syncytial virus (RR = 1.2) than did infants from villages with more than 80% served. Outpatient Staphylococcus aureus infections (RR = 5.1, all ages) and skin infection hospitalizations (RR = 2.7, all ages) were higher in low-service than in high-service villages.

Conclusions. Higher respiratory and skin infection rates were associated with a lack of in-home water service. This disparity should be addressed through sanitation infrastructure improvements.

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