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Akbaş KE, Hark BD. Evaluation of quantitative bias analysis in epidemiological research: A systematic review from 2010 to mid-2023. J Eval Clin Pract 2024. [PMID: 39031561 DOI: 10.1111/jep.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE We aimed to demonstrate the use of quantitative bias analysis (QBA), which reveals the effects of systematic error, including confounding, misclassification and selection bias, on study results in epidemiological studies published in the period from 2010 to mid-23. METHOD The articles identified through a keyword search using Pubmed and Scopus were included in the study. The articles obtained from this search were eliminated according to the exclusion criteria, and the articles in which QBA analysis was applied were included in the detailed evaluation. RESULTS It can be said that the application of QBA analysis has gradually increased over the 13-year period. Accordingly, the number of articles in which simple is used as a method in QBA analysis is 9 (9.89%), the number of articles in which the multidimensional approach is used is 10 (10.99%), the number of articles in which the probabilistic approach is used is 60 (65.93%) and the number of articles in which the method is not specified is 12 (13.19%). The number of articles with misclassification bias model is 44 (48.35%), the number of articles with uncontrolled confounder(s) bias model is 32 (35.16%), the number of articles with selection bias model is 7 (7.69%) and the number of articles using more than one bias model is 8 (8.79%). Of the 49 (53.85%) articles in which the bias parameter source was specified, 19 (38.78%) used internal validation, 26 (53.06%) used external validation and 4 (8.16%) used educated guess, data constraints and hypothetical data. Probabilistic approach was used as a bias method in 60 (65.93%) of the articles, and mostly beta (8 [13.33%)], normal (9 [15.00%]) and uniform (8 [13.33%]) distributions were selected. CONCLUSION The application of QBA is rare in the literature but is increasing over time. Future researchers should include detailed analyzes such as QBA analysis to obtain inferences with higher evidence value, taking into account systematic errors.
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Affiliation(s)
- Kübra Elif Akbaş
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Betül Dağoğlu Hark
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Fırat University, Elazig, Turkey
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Niu S, Cao Y, Chen R, Bedi M, Sanders AP, Ducatman A, Ng C. A State-of-the-Science Review of Interactions of Per- and Polyfluoroalkyl Substances (PFAS) with Renal Transporters in Health and Disease: Implications for Population Variability in PFAS Toxicokinetics. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:76002. [PMID: 37418334 DOI: 10.1289/ehp11885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are ubiquitous in the environment and have been shown to cause various adverse health impacts. In animals, sex- and species-specific differences in PFAS elimination half-lives have been linked to the activity of kidney transporters. However, PFAS molecular interactions with kidney transporters are still not fully understood. Moreover, the impact of kidney disease on PFAS elimination remains unclear. OBJECTIVES This state-of-the-science review integrated current knowledge to assess how changes in kidney function and transporter expression from health to disease could affect PFAS toxicokinetics and identified priority research gaps that should be addressed to advance knowledge. METHODS We searched for studies that measured PFAS uptake by kidney transporters, quantified transporter-level changes associated with kidney disease status, and developed PFAS pharmacokinetic models. We then used two databases to identify untested kidney transporters that have the potential for PFAS transport based on their endogenous substrates. Finally, we used an existing pharmacokinetic model for perfluorooctanoic acid (PFOA) in male rats to explore the influence of transporter expression levels, glomerular filtration rate (GFR), and serum albumin on serum half-lives. RESULTS The literature search identified nine human and eight rat kidney transporters that were previously investigated for their ability to transport PFAS, as well as seven human and three rat transporters that were confirmed to transport specific PFAS. We proposed a candidate list of seven untested kidney transporters with the potential for PFAS transport. Model results indicated PFOA toxicokinetics were more influenced by changes in GFR than in transporter expression. DISCUSSION Studies on additional transporters, particularly efflux transporters, and on more PFAS, especially current-use PFAS, are needed to better cover the role of transporters across the PFAS class. Remaining research gaps in transporter expression changes in specific kidney disease states could limit the effectiveness of risk assessment and prevent identification of vulnerable populations. https://doi.org/10.1289/EHP11885.
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Affiliation(s)
- Shan Niu
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuexin Cao
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruiwen Chen
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megha Bedi
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison P Sanders
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alan Ducatman
- Department of Occupational and Environmental Health Sciences, West Virginia University, Morgantown, West Virginia, USA
| | - Carla Ng
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Andersen ME, Hagenbuch B, Apte U, Corton JC, Fletcher T, Lau C, Roth WL, Staels B, Vega GL, Clewell HJ, Longnecker MP. Why is elevation of serum cholesterol associated with exposure to perfluoroalkyl substances (PFAS) in humans? A workshop report on potential mechanisms. Toxicology 2021; 459:152845. [PMID: 34246716 PMCID: PMC9048712 DOI: 10.1016/j.tox.2021.152845] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 01/09/2023]
Abstract
Serum concentrations of cholesterol are positively correlated with exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) in humans. The associated change in cholesterol is small across a broad range of exposure to PFOA and PFOS. Animal studies generally have not indicated a mechanism that would account for the association in humans. The extent to which the relationship is causal is an open question. Nonetheless, the association is of particular importance because increased serum cholesterol has been considered as an endpoint to derive a point of departure in at least one recent risk assessment. To gain insight into potential mechanisms for the association, both causal and non-causal, an expert workshop was held Oct 31 and Nov 1, 2019 to discuss relevant data and propose new studies. In this report, we summarize the relevant background data, the discussion among the attendees, and their recommendations for further research.
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Affiliation(s)
| | - Bruno Hagenbuch
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd - MS 1018, Kansas City, KS 66160, USA.
| | - Udayan Apte
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, 3901 Rainbow Blvd - MS 1018, Kansas City, KS 66160, USA.
| | - J Christopher Corton
- Advanced Experimental Toxicology Models Branch, Biomolecular and Computational Toxicology Division, Center for Computational Toxicology and Exposure, US Environmental Protection Agency, 109 T.W. Alexander Dr., MD B105-03, Research Triangle Park, NC 27711, USA.
| | - Tony Fletcher
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Christopher Lau
- Reproductive and Developmental Toxicology Branch, Public Health and Integrated Toxicology Division, Mail Code B105-04, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
| | - William L Roth
- U.S. Food and Drug Administration (Retired), Numerical Animals, 16005 Frontier Rd., Reno, NV 89508, USA.
| | - Bart Staels
- Univ. Lille, Inserm, CHU de Lille, Institut Pasteur de Lille, U1011-EGID, F-59019 Lille, France.
| | - Gloria L Vega
- Center for Human Nutrition, Dallas, TX, USA; Department of Clinical Nutrition, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9052, USA.
| | - Harvey J Clewell
- Ramboll US Consulting, Inc., 3214 Charles B. Root Wynd, Suite 130, Raleigh, NC 27612, USA.
| | - Matthew P Longnecker
- Ramboll US Consulting, Inc., 3214 Charles B. Root Wynd, Suite 130, Raleigh, NC 27612, USA.
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Andersen ME, Mallick P, Clewell HJ, Yoon M, Olsen GW, Longnecker MP. Using quantitative modeling tools to assess pharmacokinetic bias in epidemiological studies showing associations between biomarkers and health outcomes at low exposures. ENVIRONMENTAL RESEARCH 2021; 197:111183. [PMID: 33887277 DOI: 10.1016/j.envres.2021.111183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
Biomarkers of exposure can be measured at lower and lower levels due to advances in analytical chemistry. Using these sensitive methods, some epidemiology studies report associations between biomarkers and health outcomes at biomarker levels much below those associated with effects in animal studies. While some of these low exposure associations may arise from increased sensitivity of humans compared with animals or from species-specific responses, toxicology studies with drugs, commodity chemicals and consumer products have not generally indicated significantly greater sensitivity of humans compared with test animals for most health outcomes. In some cases, these associations may be indicative of pharmacokinetic (PK) bias, i.e., a situation where a confounding factor or the health outcome itself alters pharmacokinetic processes affecting biomarker levels. Quantitative assessment of PK bias combines PK modeling and statistical methods describing outcomes across large numbers of individuals in simulated populations. Here, we first provide background on the types of PK models that can be used for assessing biomarker levels in human population and then outline a process for considering PK bias in studies intended to assess associations between biomarkers and health outcomes at low levels of exposure. After providing this background, we work through published examples where these PK methods have been applied with several chemicals/chemical classes - polychlorinated biphenyls (PCBs), perfluoroalkyl substances (PFAS), polybrominated biphenyl ethers (PBDE) and phthalates - to assess the possibility of PK bias. Studies of the health effects of low levels of exposure will be improved by developing some confidence that PK bias did not play significant roles in the observed associations.
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Petersen JM, Ranker LR, Barnard-Mayers R, MacLehose RF, Fox MP. A systematic review of quantitative bias analysis applied to epidemiological research. Int J Epidemiol 2021; 50:1708-1730. [PMID: 33880532 DOI: 10.1093/ije/dyab061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Quantitative bias analysis (QBA) measures study errors in terms of direction, magnitude and uncertainty. This systematic review aimed to describe how QBA has been applied in epidemiological research in 2006-19. METHODS We searched PubMed for English peer-reviewed studies applying QBA to real-data applications. We also included studies citing selected sources or which were identified in a previous QBA review in pharmacoepidemiology. For each study, we extracted the rationale, methodology, bias-adjusted results and interpretation and assessed factors associated with reproducibility. RESULTS Of the 238 studies, the majority were embedded within papers whose main inferences were drawn from conventional approaches as secondary (sensitivity) analyses to quantity-specific biases (52%) or to assess the extent of bias required to shift the point estimate to the null (25%); 10% were standalone papers. The most common approach was probabilistic (57%). Misclassification was modelled in 57%, uncontrolled confounder(s) in 40% and selection bias in 17%. Most did not consider multiple biases or correlations between errors. When specified, bias parameters came from the literature (48%) more often than internal validation studies (29%). The majority (60%) of analyses resulted in >10% change from the conventional point estimate; however, most investigators (63%) did not alter their original interpretation. Degree of reproducibility related to inclusion of code, formulas, sensitivity analyses and supplementary materials, as well as the QBA rationale. CONCLUSIONS QBA applications were rare though increased over time. Future investigators should reference good practices and include details to promote transparency and to serve as a reference for other researchers.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynsie R Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ruby Barnard-Mayers
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Chou WC, Lin Z. Development of a Gestational and Lactational Physiologically Based Pharmacokinetic (PBPK) Model for Perfluorooctane Sulfonate (PFOS) in Rats and Humans and Its Implications in the Derivation of Health-Based Toxicity Values. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:37004. [PMID: 33730865 PMCID: PMC7969127 DOI: 10.1289/ehp7671] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND There is a great concern on potential adverse effects of exposure to perfluorooctane sulfonate (PFOS) in sensitive subpopulations, such as pregnant women, fetuses, and neonates, due to its reported transplacental and lactational transfer and reproductive and developmental toxicities in animals and humans. OBJECTIVES This study aimed to develop a gestational and lactational physiologically based pharmacokinetic (PBPK) model in rats and humans for PFOS to aid risk assessment in sensitive human subpopulations. METHODS Based upon existing PBPK models for PFOS, the present model addressed a data gap of including a physiologically based description of basolateral and apical membrane transporter-mediated renal reabsorption and excretion in kidneys during gestation and lactation. The model was calibrated with published rat toxicokinetic and human biomonitoring data and was independently evaluated with separate data. Monte Carlo simulation was used to address the interindividual variability. RESULTS Model simulations were generally within 2-fold of observed PFOS concentrations in maternal/fetal/neonatal plasma and liver in rats and humans. Estimated fifth percentile human equivalent doses (HEDs) based on selected critical toxicity studies in rats following U.S. Environmental Protection Agency (EPA) guidelines ranged from 0.08 to 0.91 μ g / kg per day . These values are lower than the HEDs estimated in U.S. EPA guidance (0.51 - 1.6 μ g / kg per day ) using an empirical toxicokinetic model in adults. CONCLUSIONS The results support the importance of renal reabsorption/excretion during pregnancy and lactation in PFOS dosimetry and suggest that the derivation of health-based toxicity values based on developmental toxicity studies should consider gestational/lactational dosimetry estimated from a life stage-appropriate PBPK model. This study provides a quantitative tool to aid risk reevaluation of PFOS, especially in sensitive human subpopulations, and it provides a basis for extrapolating to other per- and polyfluoroalkyl substances (PFAS). All model codes and detailed tutorials are provided in the Supplemental Materials to allow readers to reproduce our results and to use this model. https://doi.org/10.1289/EHP7671.
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Affiliation(s)
- Wei-Chun Chou
- Institute of Computational Comparative Medicine, Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Zhoumeng Lin
- Institute of Computational Comparative Medicine, Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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Hölzer J, Lilienthal H, Schümann M. Human Biomonitoring (HBM)-I values for perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) - Description, derivation and discussion. Regul Toxicol Pharmacol 2021; 121:104862. [PMID: 33444659 DOI: 10.1016/j.yrtph.2021.104862] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 01/09/2023]
Abstract
In 2016, the German Human Biomonitoring Commission (HBM-C) published a statement on its decision to develop HBM-I values for Perfluorooctanoic acid (PFOA) and Perfluorooctanesulfonic acid (PFOS) (Bundesgesundheitsbl 2016, 59:1364 DOI 10.1007/s00103-016-2437-1). The HBM-I value corresponds to the concentration of a substance in a human biological material below which no adverse health effects are expected, according to current knowledge and assessment by the HBM-C, and, consequently, there is no need for action. Evidence for associations between PFOA- and PFOS-body burden and health outcomes was found for fertility and pregnancy, weights of newborns at birth, lipid metabolism, immunity, sex hormones and age at puberty/menarche, thyroid hormones, onset of menopause as well as uric acid metabolism. Significant contrasts were reported for human blood plasma concentrations between 1 and 10 ng PFOA/mL, and 1-15 ng PFOS/mL, respectively. Within the reported ranges, the HBM-C has decided to set the HBM-I-values at 2 ng PFOA/mL and 5 ng PFOS/mL blood plasma. The underlying pathomechanisms do not appear to be sufficiently clarified to provide an unambiguous explanation of the effects observed. Consistency of toxicological and epidemiological data has been considered. The available data do not indicate an unequivocal proof of a genotoxicity of PFOA and PFOS.
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Affiliation(s)
- Jürgen Hölzer
- Department for Hygiene, Social and Environmental Medicine, MA 1/31, Ruhr-University Bochum, Universitätsstrasse 150, 44801, Bochum, Germany.
| | - Hellmuth Lilienthal
- Department for Hygiene, Social and Environmental Medicine, MA 1/31, Ruhr-University Bochum, Universitätsstrasse 150, 44801, Bochum, Germany
| | - Michael Schümann
- Department for Hygiene, Social and Environmental Medicine, MA 1/31, Ruhr-University Bochum, Universitätsstrasse 150, 44801, Bochum, Germany
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Caporossi L, Capanna S, Viganò P, Alteri A, Papaleo B. From Environmental to Possible Occupational Exposure to Risk Factors: What Role Do They Play in the Etiology of Endometriosis? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020532. [PMID: 33440623 PMCID: PMC7826798 DOI: 10.3390/ijerph18020532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 01/25/2023]
Abstract
Endometriosis is a gynecological disorder characterized by the presence of endometrial stroma and glands outside the uterine cavity. A systematic review of the literature was conducted to clarify, starting from environmental exposure data, whether possible occupational risk factors may correlate with the onset of the disease. The guidelines for reporting systematic reviews of the “PRISMA” statement were followed and two databases, Scopus and PubMed, were used. Of the 422 studies selected with specific keywords, 32 publications were eligible, 28 of which referred to chemical agents and 4 related to night work. Conflicting data emerged among these studies. Although some compounds seemed to be more involved than others in the onset of endometriosis. Association with exposure to organochlorine compounds is the most supported by the epidemiological data, while other pesticide exposure did not show any clear correlation. Likewise, the hypothesis of a correlation with perfluoroalkyls exposure is not currently supported by data. The involvement of metals as risk factors has not been confirmed, while the role of night work, in the case of long service, seems to play an etiological role. In order to clarify the potential occupational risk of endometriosis development, well-designed studies are needed to evaluate the potential association between chemical compounds and disease etiology.
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Affiliation(s)
- Lidia Caporossi
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (S.C.); (B.P.)
- Correspondence:
| | - Silvia Capanna
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (S.C.); (B.P.)
| | - Paola Viganò
- IRCCS San Raffele Scientific Institute, Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, via Olgettina 60, 20132 Milan, Italy;
| | - Alessandra Alteri
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, via Olgettina 60, 20132 Milan, Italy;
| | - Bruno Papaleo
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, via Fontana Candida 1, 00078 Monte Porzio Catone, Italy; (S.C.); (B.P.)
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Dzierlenga MW, Allen BC, Clewell HJ, Longnecker MP. Pharmacokinetic bias analysis of an association between clinical thyroid disease and two perfluoroalkyl substances. ENVIRONMENT INTERNATIONAL 2020; 141:105784. [PMID: 32408218 DOI: 10.1016/j.envint.2020.105784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/06/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) has been associated with the occurrence of thyroid disease in some epidemiologic studies. We hypothesized that in a specific epidemiologic study based on the National Health and Nutrition Examination Survey, the association of clinical thyroid disease with serum concentration of PFOA and PFOS was due to reverse causality. Thyroid hormone affects glomerular filtration, which in turn affects excretion of PFOA and PFOS. We evaluated this by linking a model of thyroid disease status over the lifetime to a physiologically based pharmacokinetic model of PFOA and PFOS. Using Monte Carlo methods, we simulated the target study population and analyzed the data using multivariable logistic regression. The target and simulated populations were similar with respect to age, estimated glomerular filtration rate, serum concentrations of PFOA and PFOS, and prevalence of clinical thyroid disease. The analysis showed little or no evidence of bias from the hypothesized mechanism. The largest bias was for the fourth quartile of PFOA in females, with an odds ratio of 0.93 (95% CI, 0.90, 0.97). The reported odds ratio of clinical thyroid disease for this group was 1.63 (1.07, 2.47), and if it were corrected for the bias would have been 1.74 (1.14, 2.65). Our results suggest that little of the reported association in the target study was due to reverse causality.
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Dzierlenga MW, Moreau M, Song G, Mallick P, Ward PL, Campbell JL, Housand C, Yoon M, Allen BC, Clewell HJ, Longnecker MP. Quantitative bias analysis of the association between subclinical thyroid disease and two perfluoroalkyl substances in a single study. ENVIRONMENTAL RESEARCH 2020; 182:109017. [PMID: 31865168 DOI: 10.1016/j.envres.2019.109017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 12/06/2019] [Indexed: 05/23/2023]
Abstract
Exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) has been associated with the occurrence of thyroid disease in some epidemiologic studies. We hypothesized that in a specific epidemiologic study based on the National Health and Nutrition Examination Survey, the association of subclinical thyroid disease with serum concentration of PFOA and PFOS was due to reverse causality. Thyroid hormone affects glomerular filtration, which in turn affects excretion of PFOA and PFOS. We evaluated this by linking a model of thyroid disease status over the lifetime to physiologically based pharmacokinetic models of PFOA and PFOS. Using Monte Carlo methods, we simulated the target study population and analyzed the data using multivariable logistic regression. The target and simulated populations were similar with respect to age, estimated glomerular filtration rate, serum concentrations of PFOA and PFOS, and prevalence of subclinical thyroid disease. Our findings suggest that in the target study the associations with subclinical hypothyroidism were overstated and the results for subclinical hyperthyroidism were, in general, understated. For example, for subclinical hypothyroidism in men, the reported odds ratio per ln(PFOS) increase was 1.98 (95% CI 1.19-3.28), whereas in the simulated data the bias due to reverse causality gave an odds ratio of 1.19 (1.16-1.23). Our results provide evidence of bias due to reverse causality in a specific cross-sectional study of subclinical thyroid disease with exposure to PFOA and PFOS among adults.
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Affiliation(s)
| | | | - Gina Song
- ScitoVation, LLC, Research Triangle Park, NC, USA
| | | | | | | | | | - Miyoung Yoon
- ScitoVation, LLC, Research Triangle Park, NC, USA; ToxStrategies, Research Triangle Park, NC, USA
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Ableitung von HBM-I-Werten für Perfluoroktansäure (PFOA) und Perfluoroktansulfonsäure (PFOS) – Stellungnahme der Kommission „Humanbiomonitoring“ des Umweltbundesamts. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:474-487. [DOI: 10.1007/s00103-018-2709-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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12
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Rush EL, Singer AB, Longnecker MP, Haug LS, Sabaredzovic A, Symanski E, Whitworth KW. Oral contraceptive use as a determinant of plasma concentrations of perfluoroalkyl substances among women in the Norwegian Mother and Child Cohort (MoBa) study. ENVIRONMENT INTERNATIONAL 2018; 112:156-164. [PMID: 29274593 PMCID: PMC5899038 DOI: 10.1016/j.envint.2017.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Because oral contraceptives (OC) tends to lessen menstrual fluid loss - a route of excretion for perfluoroalkyl substances (PFASs) - we hypothesized that such use would be positively associated with PFAS concentrations. METHODS This analysis was based on the Norwegian Mother and Child Cohort (MoBa) study. We included 1090 women from two previous substudies of women enrolled from 2003 to 2007. Characteristics of OC use were obtained at baseline: use in the past 12months, duration and recency of use, age at first use. We examined log-transformed plasma concentrations of seven PFASs (perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorohexane sulfonate (PFHxS), perfluoroheptane sulfonate (PFHpS), and perfluorooctane sulfonate (PFOS)). Linear regression analyses, adjusted for maternal age, menstrual cycle length, parity, and education, were used to examine whether OC use characteristics were determinants of PFAS concentrations. RESULTS Except for PFDA and PFUnDA, women who used OCs in the 12months preceding the baseline interview had 12.9-35.7% higher PFAS concentrations than never OC users. To a lesser extent, past OC use was positively associated with PFASs (estimates ranged from 7.2-32.1%). Compared with never users, using OCs for 10 or more years was associated with increased PFAS concentrations, except for PFDA and PFUnDA (estimates for other PFASs ranged from 18.9-46.2%). We observed little effect of age at first OC use. CONCLUSIONS This analysis shows that characteristics of OC use, and duration of use in particular, may be important considerations when investigating relationships between women's reproductive outcomes and PFASs.
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Affiliation(s)
- Elise L Rush
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health in San Antonio, San Antonio, TX, USA
| | - Alison B Singer
- The Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew P Longnecker
- National Institute for Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, NC, USA
| | - Line S Haug
- Department of Exposure Assessment and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Azemira Sabaredzovic
- Department of Exposure Assessment and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Elaine Symanski
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA; Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Kristina W Whitworth
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health in San Antonio, San Antonio, TX, USA; Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA.
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