Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States

Sarah A. Collier; Li Deng; Elizabeth A. Adam; Katharine M. Benedict; Elizabeth M. Beshearse; Anna J. Blackstock; Beau B. Bruce; Gordana Derado; Chris Edens; Kathleen E. Fullerton; Julia W. Gargano; Aimee L. Geissler; Aron J. Hall; Arie H. Havelaar; Vincent R. Hill; Robert M. Hoekstra; Sujan C. Reddy; Elaine Scallan; Erin K. Stokes; Jonathan S. Yoder; Michael J. Beach

Disclosures

Emerging Infectious Diseases. 2021;27(1):140-149. 

In This Article

Results

Illnesses

We estimate that 33,600,000 (95% CrI 23,500,000–48,000,000) illnesses from the diseases in this analysis occurred in 2014, and of those, 7,150,000 (95% CrI 3,880,000–12,000,000; 21.3%) were attributed to waterborne transmission in the United States (Table 2). The diseases that caused the greatest number of domestically acquired waterborne illnesses were otitis externa (4,670,000 illnesses; 95% CrI 2,350,000–7,290,000) and norovirus infection (1,330,000 illnesses; 95% Cr 5,310–5,510,000), followed by giardiasis (415,000 illnesses; 95% CrI 140,000–816,000) and cryptosporidiosis (322,000 illnesses; 95% CrI 61,700–993,000). An estimated 96,000 domestically acquired waterborne respiratory illnesses occurred, and 2,330,000 domestically acquired waterborne enteric illnesses occurred.

Emergency Department Visits

An estimated 601,000 (95% CrI 364,000–866,000) treat-and-release emergency department visits for the included diseases were attributed to waterborne transmission in the United States in 2014 (Table 3). Otitis externa caused the largest number of visits (567,000; 95% CrI 337,000–823,000).

Hospitalizations

We estimate that these diseases were responsible for 118,000 (95% CrI 86,800–150,000) hospitalizations attributed to waterborne transmission in the United States (Table 3). The diseases with the largest number of hospitalizations were NTM infection (51,400 hospitalizations; 95% CrI 26,800–74,100), otitis externa (23,200 hospitalizations; 95% CrI 13,900–33,600), and Pseudomonas pneumonia (15,500 hospitalizations; 95% CrI 4,130–28,100). An estimated 77,700 respiratory hospitalizations were attributed to waterborne transmission, and 10,900 enteric hospitalizations were attributed to waterborne transmission.

Deaths

The diseases examined in this analysis were responsible for 6,630 deaths (95% CrI 4,520–8,870) attributed to waterborne transmission in the United States in 2014 (Table 3). The diseases with the largest number of deaths attributed to waterborne transmission in the United States were NTM infection (3,800, 95% CrI 1,950–5,620), Legionnaires' disease (995, 95% CrI 655–1,310), and Pseudomonas pneumonia (730, 95% CrI 185–1,460). An estimated 5,530 deaths from respiratory disease were attributed to waterborne transmission (83% of all domestically acquired waterborne deaths), and 131 deaths from enteric diseases were attributed to waterborne transmission.

Direct Healthcare Costs of ED Visits and Hospitalizations

Pseudomonas septicemia had the highest cost per hospital stay ($38,200; 95% CrI $6,340–$172,000), followed by Legionnaires' disease ($37,300, CrI $7,950–$149,000) (Table 4). Payments for ED visits and hospitalizations attributed to waterborne transmission in the United States totaled US $3.33 billion (95% CrI $1.37–$8.77 billion) in 2014 dollars (Table 5). This amount included $1.33 billion (95% CrI $361 million–$4.44 billion) in commercial insurer payments, $1.52 billion (95% CrI $338 million–$5.84 billion) in Medicare payments, and $284 million (95% CrI $62.7 million–$906 million) in Medicaid payments (Appendix 3 Tables 1–3). The costliest diseases were NTM infection ($1.53 billion; 95% CrI $272 million–$6.38 billion), otitis externa ($564 million; 95% CrI $187 million–$1.57 billion), and Pseudomonas pneumonia ($453 million; 95% CrI $49.9 million–$1.95 billion). An estimated $2.39 billion in direct healthcare costs from domestically acquired waterborne respiratory disease were incurred (72% of all costs from domestically acquired waterborne disease), as were $160 million in direct healthcare costs from domestically acquired waterborne enteric diseases.

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