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Review of Epidemiological Studies of Drinking-Water Turbidity in Relation to Acute Gastrointestinal Illness
Journal article   Open access   Peer reviewed

Review of Epidemiological Studies of Drinking-Water Turbidity in Relation to Acute Gastrointestinal Illness

Anneclaire J. De Roos, Patrick L. Gurian, Lucy F. Robinson, Arjita Rai, Issa Zakeri and Michelle C. Kondo
Environmental health perspectives, v 125(8), 086003
01 Aug 2017
PMID: 28886603
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Review of Epidemiological Studies of Drinking-Water Turbidity in Relation to Acute Gastrointestinal Illness965.01 kBDownloadView
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https://doi.org/10.1289/EHP1090View
Published, Version of Record (VoR)access removed by US government, 1 Dec 2025 Restricted

Abstract

Life Sciences & Biomedicine Public, Environmental & Occupational Health Science & Technology Ecology Environmental Science Toxicology
BACKGROUND: Turbidity has been used as an indicator of microbiological contamination of drinking water in time-series studies attempting to discern the presence of waterborne gastrointestinal illness; however, the utility of turbidity as a proxy exposure measure has been questioned. OBJECTIVES: We conducted a review of epidemiological studies of the association between turbidity of chinking-water supplies and incidence of acute gastrointestinal illness (AGI), including a synthesis of the overall weight of evidence. Our goal was to evaluate the potential for causal inference from the studies. METHODS: We identified 14 studies on the topic (distinct by region, time period and/or population). We evaluated each study with regard to modeling approaches, potential biases, and the strength of evidence. We also considered consistencies and differences in the collective results. DISCUSSION: Positive associations between drinking-water turbidity and AGI incidence were found in different cities and time periods, and with both unfiltered and filtered supplies. There was some evidence for a stronger association at higher turbidity levels. The studies appeared to adequately adjust for confounding. There was fair consistency in the notable lags between turbidity measurement and AGI identification, which fell between 6 and 10 d in many studies. CONCLUSIONS: The observed associations suggest a detectable incidence of waterborne AGI from drinking water in the systems and time periods studied. However, some discrepant results indicate that the association may be context specific. Combining turbidity with seasonal and climatic factors, additional water quality measures, and treatment data may enhance predictive modeling in future studies.

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Collaboration types
Domestic collaboration
Web of Science research areas
Environmental Sciences
Public, Environmental & Occupational Health
Toxicology
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