Harnessing electronic health records to study emerging environmental disasters: a proof of concept with perfluoroalkyl substances (PFAS)

Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer: Systematic review and meta-analysis

Per- and polyfluoroalkyl substances (PFAS) exposure is a potential risk factor for thyroid cancer and may be a contributor to the increasing thyroid cancer incidence rates. A systematic review and meta-analysis was performed to summarize all human studies to date investigating the association between PFAS exposure and thyroid cancer. A search of the National Library of Medicine and National Institutes of Health PubMed and Scopus databases was done to identify relevant articles published in English through January 2024. Studies reporting the association between PFAS exposure and thyroid cancer using odds ratios (OR) were included in the meta-analysis with summary estimate calculated using a random effects model (n=5). Perfluorooctanoic acid (PFOA) was the most investigated PFAS. Results of the included studies varied, ranging from significant positive to significant negative associations with thyroid cancer incidence for different PFAS. Meta-analyses of PFOA, Perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorohexanesulfonic acid (PFHxS) were not significant. This comprehensive review of the current literature highlights the limited knowledge and inconsistent results of this association. Large longitudinal cohort studies with varying time between sample collection and thyroid cancer diagnosis are needed to better understand the role of PFAS exposure on thyroid carcinogenesis.

Community-level exposomics: a population-centered approach to address public health concerns

Environmental factors affecting health and vulnerability far outweigh genetics in accounting for disparities in health status and longevity in US communities. The concept of the exposome, the totality of exposure from conception onwards, provides a paradigm for researchers to investigate the complex role of the environment on the health of individuals. We propose a complementary framework, community-level exposomics, for population-level exposome assessment. The goal is to bring the exposome paradigm to research and practice on the health of populations, defined by various axes including geographic, social, and occupational. This framework includes the integration of community-level measures of the built, natural and social environments, environmental pollution-derived from conventional and community science approaches, internal markers of exposure that can be measured at the population-level and early responses associated with health status that can be tracked using population-based monitoring. Primary challenges to the implementation of the proposed framework include needed advancements in population-level measurement, lack of existing models with the capability to produce interpretable and actionable evidence and the ethical considerations of labeling geographically-bound populations by exposomic profiles. To address these challenges, we propose a set of recommendations that begin with greater engagement with and empowerment of affected communities and targeted investment in community-based solutions. Applications to urban settings and disaster epidemiology are discussed as examples for implementation.

Investigating Three Classification Methods for Per/Poly-Fluoroalkyl Substance (PFAS) Exposure from Electronic Health Records And Potential for Bias

Per-/poly-fluoroalkyl substances (PFAS) are a group of manmade compounds with known human toxicity and evidence of contamination in drinking water throughout the US. We augmented our electronic health record data with geospatial information to classify PFAS exposure for our patients living in New Jersey. We explored the utility of three different methods for classifying PFAS exposure that are popularly used in the literature, resulting in different boundary types: public water supplier service area boundary, municipality, and ZIP code. We also explored the intersection of the three boundaries. To study the potential for bias, we investigated known PFAS exposure-disease associations, specifically hypertension, thyroid disease and parathyroid disease. We found that both the significance of the associations and the effect size varied by the method for classifying PFAS exposure. This has important implications in knowledge discovery and also environmental justice as across cohorts, we found a larger proportion of Black/African-American patients PFAS-exposed.

Distribution, source and ecological risk of per- and polyfluoroalkyl substances in Chinese municipal wastewater treatment plants

Municipal wastewater treatment plants (WWTPs) are sinks of per- and polyfluoroalkyl substances (PFASs) generated by human activities and are also sources of PFASs in aquatic environment. This study analyzed distribution, source and ecological risk of 14 PFASs in influent and effluent samples from 148 Chinese municipal WWTPs. Composition and concentrations of PFASs in the influents and effluents had obvious spatial differences. Fluoropolymer processing aids/wrappers and textile treatments/coatings were found to be the dominant sources in WWTP influents, which accounted for 78.34% of all sources. Consumption structure and metal and transportation equipment manufacturing affected the spatial differences of PFASs in WWTPs. Further, mean removal rate of total PFASs in all WWTPs was -5.45%. The conventional treatment processes can not effectively remove PFASs and no significant difference was found among different treatment processes. However, risk quotient values of PFASs in effluents were all below 0.1, indicating low risk or no risk to aquatic organisms. It should be noted that the composition, source and ecological risk of PFASs in east China were different from the other regions, which need more attentions. This study sheds insights into occurrencesof PFASs in municipal WWTPs, which should be helpful for their control strategy development.

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

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.