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Multimorbidity and PFAS exposure in an Electronic Health Record cohort
Citation:
Ward-Caviness, C., J. Moyer, A. Weaver, AND R. Devlin. Multimorbidity and PFAS exposure in an Electronic Health Record cohort. International Society for Environmental Epidemiology-Virtual, NYC, NY, August 23 - 26, 2021.
Impact/Purpose:
Describes associations between PFAS exposure in NC and the occurrence of multiple chronic conditions
Description:
Background: Despite discontinued manufacture, per and poly-fluoroalkyl substances (PFAS) are an ongoing health concern for many communities due to their long half-lives. Several studies have reported on health effects linked to PFAS, but few studies have examined whether PFAS exposure increases multimorbidity, i.e. the co-occurrence of multiple chronic diseases. Methods We linked a random sample of 10,168 patients from the University of North Carolina Healthcare System with PFAS exposure as part of the EPA CARES resource. PFAS exposure was assessed using public water system testing data from the Unregulated Contaminant Monitoring Rule 3. We used logistic regression and cumulative link models (logit link) to associate exposure to PFOA and PFHpA with the occurrence of two or more of 17 chronic conditions determined by ICD-9 and ICD-10 codes in a cross-sectional study design. Models were adjusted for age, race, sex, smoking, socioeconomic status, and county-level confounders such as access to healthy foods and healthcare. We restricted to individuals who never moved to reduce exposure misclassification. Results are presented as the odds ratio (OR) and associated 95% confidence interval (CI). Results Residing in a zip code served by a public water system that tested positive for PFOA or PFHpA was associated with increased prevalence of multimorbidity as compared to have no observed chronic diseases (OR = 1.32; 95% CI = 1.09-1.60). Exposure to either of these PFAS increased the odds of having an additional chronic condition by 38% (OR = 1.38; 95% CI = 1.17-1.62). Associations were similar when looking at PFOA and PFHpA separately. Among diseases with at least 5% prevalence in our participants, hypertension had the strongest association with PFAS exposure (OR = 1.45; 95% CI = 1.18-1.80). Conclusion Exposure to PFAS via public water systems is associated with substantial increases in multimorbidity in a random sample of North Carolina hospital-going residents. These associations indicate the potential for PFAS to affect multiple organ systems and highlight the ongoing need to study these “forever chemicals”. This abstract does not represent EPA policy.