Academic journal article Environmental Health Perspectives

Tracking Patterns of Enteric Illnesses in Populations and Communities

Academic journal article Environmental Health Perspectives

Tracking Patterns of Enteric Illnesses in Populations and Communities

Article excerpt

BACKGROUND: Enteric illness arising from contaminated water and food is a major health concern worldwide, and tracking the incidences and severity of outbreaks is still a challenging task. Most developed and developing countries have administrative databases for medical visits and services maintained by the government and/or health insurance authorities. Although these databases could be extremely valuable resources to track patterns of environmental and other health issues, test hypotheses, and develop epidemiologic models and predictions, very little research has been done to develop methods to ensure the robustness of such databases and to demonstrate their utility as a research tool.

OBJECTIVES: We used the Medical Services Plan (MSP) database of British Columbia, Canada, to develop innovative ways to use medical billing and fee-for-services data to track long-term patterns of enteric illness at the level of populations and communities.

RESULTS: To illustrate the power and robustness of the method, we provided several examples covering 8 years of data from each of four communities covering a large range of population size. Not only could this method generalize to other diseases for which specific fee item markers can be found, but also it gives results consistent with a known outbreak and yields data patterns, which could not be revealed by the currently used methods. Because diagnostic code and fee item data for medical services are collected by most medical insurance agencies, our method can have global applications for tracking enteric and other illnesses at the level of populations and communities.

KEY WORDS: diagnostic code, drinking water, enteric illness, fee item data, Medical Services Plan, methods for tracking enteric disease, waterborne disease. Environ Health Perspect 115: 58-64 (2007). doi:10.1289/ehp.9199 available via [Online 14 September 2006]


Enteric illness associated with microbial contamination of water and food is a global issue (Payment et al. 1997; World Health Organization 2006). Unsustainable population growth, increased loading of pollutants and pathogens into source water, and associated contamination of water and perishable food are some of the major causes of increasing rates of enteric illnesses worldwide (Davies and Mazumder 2003). The Milwaukee tragedy in Wisconsin (MacKenzie et al. 1994) and the Walkerton tragedy in Ontario (Clark et al. 2003) are some of the examples of epidemic outbreaks of enteric illnesses originating from contaminated drinking water. Although these outbreaks were severe enough to be recognized as epidemic situations, many minor outbreaks of enteric illnesses are not recorded or recognized because robust methods of tracking the long-term patterns of enteric illnesses in a given population or community are yet to be fully developed.

Like most government health plans, the British Columbia Medical Services Plan (MSP) maintains an electronic database, Program Monitoring and Education Master File (PME-MAST) of the British Columbia government, consisting of records for every service billed to it, approximately 50,000,000 services per year provided to a population of about 4,000,000 in the Province of British Columbia. Details on fee items covered by British Columbia MSP are indicated in Ministry of Health Services (1985, 1998). Because MSP is the sole provider of medical insurance in British Columbia, and the fee-for-service is the dominant business arrangement, this database amounts to about 90% of the services provided by the physicians or surgeons in the province. In addition, this database includes services provided through Worker's Compensation and through the Insurance Corporation of British Columbia, and is reasonably accurate since 1990. Thus the database is an extraordinarily comprehensive record of medical services, and as such it is a significant resource to model and track patterns of illnesses. …

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