标题：Modeling Spatial Risk of Diarrheal Disease Associated with Household Proximity to Untreated Wastewater Used for Irrigation in the Mezquital Valley, Mexico
摘要：Background: Reusing wastewater for irrigation is a longstanding practice that enhances crop yields and improves climate resilience. Without treatment, however, wastewater contains harmful pathogens and chemicals. Reuse of untreated wastewater has been shown to be harmful to the health of nearby communities, but the routes of exposure are unknown and do not appear to be occupational. Some routes occur throughout entire communities, such as food contamination. Other routes may be spatially dependent, such as spread by domestic animals or through aerosolization. Objectives: To examine whether those wastewater exposure routes with a spatial dependency affect health, we estimated the risks of diarrheal disease in children under age 5 associated with living near wastewater canals, while adjusting for potential individual- and household-level confounders. Methods: We conducted three surveys over 1 y in the Mezquital Valley, Mexico, to measure diarrhea in children. The distance between each participating household and a wastewater canal was measured using GPS coordinates. The association between proximity and diarrhea was estimated with a multilevel logistic regression model accounting for spatial autocorrelation. Results: A total of 564 households completed one to three surveys, resulting in 1,856 survey observations of 646 children. Children living 100 m from a canal had 45% lower odds of diarrhea than those living within 10 m of a canal, and children living 1000 m away had 70% lower odds of diarrhea [ 100 m vs. 10 m adjusted odds ratio ( OR ) = 0.55 , 95% credible interval (CI): 0.33, 0.91; 1000 m vs. 10 m adjusted OR = 0.30 , 95% CI: 0.11, 0.82]. Discussion: The estimated decline in diarrheal prevalence with household distance from a canal persisted after controlling for occupational exposure. Identifying the specific routes of exposure that drive this relationship will help identify which interventions, such as upstream treatment, can reduce health risks for entire communities where wastewater exposure occurs.
