Association between water source and chronic gastrointestinal diseases in Chinese: A cross-sectional and longitudinal study

Abstract

BackgroundGastrointestinal health is closely associated with the quality of the water supply. However, long-term associations between the water supply type and chronic gastrointestinal disease (CGD) are unclear.MethodThe water supply was categorized as “tap-water” or “non-tap water” use. Changes in water source use were categorized into four types: “non-tap water both at baseline and in follow-ups,” “non-tap water at baseline and tap-water in follow-ups,” “tap-water at baseline and non-tap water in follow-ups,” or “tap-water at baseline and in follow-ups.” We explored the association between tap-water use (and changes therein) and the risk of CGD in a cross-sectional and longitudinal population study based on national cohort data from 2011 to 2018.ResultsAfter the inclusion and exclusion process, 13,332 and 9,688 participants were included in the cross-sectional and longitudinal analyses, respectively. Tap-water use was associated with fewer CGD cases at baseline (OR = 0.98, 95% CI: 0.90, 1.07). Tap-water use at baseline was associated with significantly lower incidence of CGD in follow-ups (HR = 0.70, 95% CI: 0.70, 0.90). Compared with consistent non-tap water use in both baseline and follow-ups, switching from non-tap water to tap-water use in follow-ups was associated with a lower risk of CGD (HR = 0.79, 95% CI: 0.64, 0.97), tap water use at both baseline and in follow-ups was associated with a lower risk of CGD (HR = 0.72, 95% CI: 0.59, 0.88). The decreased risk of CGD followed a linear trend (Pfortrend < 0.01). Adjustment for indoor solid fuel use and outdoor air pollution exposure to PM2.5 did not change the association between tap water use and CGD.ConclusionTap water use was associated with a reduced risk of incident CGD. The results from this study should aid in effect assessment for water purification strategies and public decision support for gastrointestinal health management.