Relationship between race and community water and sewer service in North Carolina, USA

PLoS One. 2018 Mar 21;13(3):e0193225. doi: 10.1371/journal.pone.0193225. eCollection 2018.


Previous evidence has identified potential racial disparities in access to community water and sewer service in peri-urban areas adjacent to North Carolina municipalities. We performed the first quantitative, multi-county analysis of these disparities. Using publicly available data, we identified areas bordering municipalities and lacking community water and/or sewer service in 75 North Carolina counties. Logistic regression was performed to evaluate the relationship between race and access to service in peri-urban areas, controlling for population density, median home value, urban status, and percent white in the adjacent municipality. In the peri-urban areas analyzed, 67% of the population lacked community sewer service, and 33% lacked community water service. In areas other than those with no black residents, odds of having community water service (p<0.01) or at least one of the two services (p<0.05) were highest for census blocks with a small proportion of black residents and lowest in 100% black census blocks, though this trend did not hold for access to community sewer service alone. For example, odds of community water service were 85% higher in areas that were greater than 0% but less than 22% black than in 100% black areas (p<0.001). Peri-urban census blocks without black populations had the lowest odds of community water service, community sewer service, and at least one of the two services, but this difference was only statistically significant for sewer. Peri-urban areas lacking service with no black residents were wealthier than 100% black areas and areas with any percent black greater than 0%. Findings suggest two unserved groups of differing racial and socioeconomic status: (1) lower-income black populations potentially excluded from municipal services during the era of legal racial segregation and (2) higher-income non-black populations. Findings also suggest greater racial disparities in community water than community sewer services statewide.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making*
  • Humans
  • North Carolina
  • Racial Groups*
  • Sanitary Engineering
  • Sewage*
  • Social Welfare*
  • Waste Disposal, Fluid
  • Water Supply*


  • Sewage

Grant support

This work was supported by the Robert Wood Johnson Foundation ( under Mentored Research Scientist Development Award 70580; and the University of North Carolina Gillings School of Global Public Health University Cancer Research Fund ( for 2014-2015. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.