PFAS & Multimorbidity: Using Electronic Health Records to probe systemic effects
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BACKGROUND AND AIM: Despite discontinued manufacture, per and poly-fluoroalkyl substances (PFAS) are a health concern for many communities due to their long half-lives. Several studies have associated PFAS with health effects, but few have examined whether PFAS exposure increases multimorbidity METHODS: A random sample of 10,168 patients from the University of North Carolina Healthcare System was evaluated for prevalence of multiple chronic health conditions and potential exposure to PFAS using electronic health records. PFAS exposure was assessed using data from the Unregulated Contaminant Monitoring Rule 3 based on residential zip code. We used logistic regression and cumulative link models (logit link) to associate public water system PFOA and PFHpA testing above the minimum reporting level with multimorbidity, i.e. the co-occurrence of two or more chronic diseases out of 17 chronic diseases determined by ICD-9 and ICD-10 codes. Models were adjusted for age, race, sex, smoking, socioeconomic status, and county-level confounders such as access to healthy foods and healthcare. Results are presented as the odds ratio (OR) and associated 95% confidence interval (CI). RESULTS:Increased prevalence of multimorbidity (OR = 1.32; 95% CI = 1.09-1.60) was associated with residing in a zip code served by a public water system that reported results above the MRL for PFOA or PFHpA. 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). 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). CONCLUSIONS:This study demonstrates that exposure to PFAS via public water systems is associated with multimorbidity. 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. KEYWORDS: PFAS, multi-morbidity, electronic health records