Associations between PFAS occurrence and multimorbidity as observed in an electronic health record cohort

Abstract

Background: Per and polyfluoroalkyl substances (PFAS) are associated with health outcomes ranging from cancer to high cholesterol. However, there has been little examination of how PFAS exposure might impact the development of multiple chronic diseases, known as multimorbidity. Here, we associated the presence of one or more PFAS in water systems serving the zip code of residence with chronic disease and multimorbidity. Methods: We used data from the unregulated contaminant monitoring rule 3 to estimate exposure to PFAS for a random sample of 10,168 patients from the University of North Carolina Healthcare System. The presence of 16 chronic diseases was determined via. their electronic health records. We used a logistic regression model in a cross-sectional study design to associate the presence of one or more PFAS with multimorbidity. Models were adjusted for age, race, sex, smoking status, socioeconomic status, and 20 county-level confounders. Results: There were four PFAS found in water systems that served at least one zip code represented in our patient data: PFOA, PFHpA, PFOS, and PFHxS. Exposure to any PFAS was associated with a odds ratio of 1.25 for multimorbidity (95% confidence interval = 1.09, 1.45). Among the chronic diseases with at least 300 cases, we observed associations with dyslipidemia, hypertension, ischemic heart disease, and osteoporosis. Conclusion: Exposure to PFAS is associated with a range of chronic diseases as well as multimorbidity. Accounting for the joint impacts of PFAS on multiple chronic conditions may give an increasingly clear picture of the public health impacts of PFAS.

Fluorosurfactants in groundwater increase the incidence of chronic health conditions among California Medicare beneficiaries

“…The results reported here are consistent with a previous study in North Carolina based on electronic health records (Ward-Caviness, Moyer et al 2022). That study also reported similar associations between presence of any PFAS detected in the drinking water system with hypertension (OR 1.32 (1.15, 1.52)) and chronic kidney disease (OR 1.14 (0.87, 1.51)).…”

“…Cardiovascular disease has been linked to PFAS by experimental and epidemiologic studies (Meneguzzi, Fava et al 2021) (Meneguzzi, Fava et al 2021, Wen, Wang et al 2022). Hypertension and dyslipidemia have been linked to serum PFAS among Norwegian adolescents (Averina, Brox et al 2021), US women (Ding, Karvonen-Gutierrez et al 2022) and adolescents (Ma, Xu et al 2019), and to PFAS drinking water contamination among North Carolina adults (Ward-Caviness, Moyer et al 2022). Preeclampsia, acute onset hypertension in pregnant women, and other reproductive related outcomes were found to be associated with PFAS in two large systematic reviews (Gao, Ni et al 2021, Rickard, Rizvi et al 2022).…”

“…Nevertheless, the results of this study indicate that PFAS has a direct association with these chronic health conditions beyond that mediated by hypertension. Ward-Caviness et al (Ward-Caviness, Moyer et al 2022) similarly indicated that the health effects of the exposure to PFAS are not specific and may be associated with multiple chronic conditions.…”

Perfluoroalkyl/Polyfluoroalkyl Substances: Links to Cardiovascular Disease Risk

“…An ecological study conducted in North Carolina (United States, 10 168 participants) showed that exposure to PFOA, PFHxS, and PFOS in drinking water was associated with the risk of hypertension. 91 Analyses of populations in the contaminated Veneto Region (Italy) showed that PFOA, PFNA, PFHxS, and PFOS are associated with hypertension. 81,82 Consistent with the analyses of blood pressure, analyses of NHANES cohorts showed that PFOA, PFNA, and PFOS are associated with hypertension risk.…”

“…A survey of the US general population (NHANES, 2003-2014; 8948 participants) showed that PFOA, PFNA, PFHxS, and PFOS serum concentrations correlated with total serum cholesterol and LDL-C. 104 PFOA and PFHxS concentrations also were linked with HDL-C. 104 An ecological study of people living in a contaminated region of North Carolina, USA (10 168 participants), reported that exposure to PFAS (PFOA, PFOS, and PFHxS) in drinking water was associated with an increased risk of dyslipidemia. 91 Additional analyses of people living in North Carolina (49 and 326 participants) exposed to contaminated drinking water showed that PFOA, PFNA, PFHxS, and PFOS (but not PFDA) were associated with higher total serum cholesterol and non-HDL-C. 105,106 Analyses of participants in the Pounds Lost study (United States, 326 participants) demonstrated that PFOA was associated with higher serum ApoB (apolipoprotein B) and ApoC-III (apolipoprotein C-III), PFDA was linked with higher intermediate-density lipoprotein cholesterol+LDL-C+ApoC-III, and PFHxS was associated with higher HDL-C+ApoC-III; no associations were reported for PFNA or PFOS. 107 Along similar lines, analysis of the general Canadian population (CHMS [2007-2009, 2009-2011, and 2016-2017], 6045 participants) showed that PFOA, PFDA, PFHxS, and PFOS were all associated with higher total cholesterol.…”