Thomas W. Hennessy ^1*, Troy Ritter ², Robert C. Holman ³, Dana L. Bruden ⁴, Krista L. Yorita ³, Lisa Bulkow ⁴, James E Cheek ⁵, Rosalyn J. Singleton ², Jeff Smith ²

¹ Centers for Disease Control and Prevention
² Alaska Native Tribal Health Consortium
³ CDC Division of Viral and Rickettsial Diseases
⁴ CDC Arctic Investigations Program
⁵ Indian Health Service

^* To whom correspondence should be addressed. E-mail: tbh0{at}cdc.gov.

	Abstract

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.

Key Words: Child and Adolescent Health, Epidemiology, Infections, Native Americans, Rural Health, Socioeconomic Factors