Drinking Water Violations and Environmental Justice in the United States, 2011-2015.

Objectives. To assess the extent to which drinking water violations in the United States differed on the basis of county race/ethnicity and socioeconomic status using the primary county served by the community water system (CWS) as the unit of analysis and to determine whether counties with higher proportions of underrepresented groups were disproportionately burdened with repeat violations. Methods. We used multivariable logistic regression to calculate odds ratios of contextual environmental justice covariates associated with initial and repeat drinking water violations. We obtained violations from the federal Safe Drinking Water Information System. Results were nonstratified and stratified on the basis of population size served by the CWS. Results. Stratified multivariable logistic regression results revealed previously unobservable patterns in nonstratified findings. Minorities face significant challenges, including exposure to poor water quality. The most notable differences in both initial and repeat violations that we observed were among CWSs that serve large populations. Our most consistent finding was the positive association of initial and repeat violations with the proportion of those who were uninsured, irrespective of stratification. Conclusions. Greater efforts are needed to ensure that counties with higher proportions of minorities, uninsured households, and low-income households have access to safe drinking water, irrespective of the size of population served by the CWS.