Estimates of Healthcare Utilization and Deaths from Waterborne Pathogen Exposure in Ontario, Canada

Abstract

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, hospitalizations, 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 hospitalizations, and 0.52 deaths. The corresponding 5th-95th percentile estimates were (per 100,000 population): 13-158 ED visits, 5-22 hospitalizations, and 0.29-0.83 deaths. The burden of disease due to unspecified pathogens dominated these rates: 99% for ED visits, 63% for hospitalizations, and 40% for deaths. However, when a causative pathogen was specified, the majority of hospitalizations (83%) and deaths (97%) resulted from exposure to the opportunistic pathogens Legionella spp., nontuberculous 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.