Table 2.
Baseline characteristics [ (%)] of participants in the NHANES follow-up study from 1999–2014 to 31 December 2015 ().
Characteristics | Total () | Total serum PFAS | Serum PFOA concentration | Serum PFOS concentration | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Low () | Medium () | High () | -Value | Tertile 1 () | Tertile 2 () | Tertile 3 () | -Value | Tertile 1 () | Tertile 2 () | Tertile 3 () | -Value | ||
Deaths | 1,251 (7.0) | 313 (4.4) | 532 (6.4) | 406 (13.2) | 322 (4.6) | 418 (7.2) | 511 (9.1) | 199 (2.7) | 372 (6.0) | 680 (12.2) | |||
Heart disease | 372 (2.1) | 81 (1.0) | 184 (2.2) | 107 (3.5) | 100 (1.4) | 128 (2.2) | 144 (2.6) | 0.158 | 62 (0.7) | 129 (2.2) | 181 (3.3) | ||
Cancer | 248 (1.4) | 43 (0.4) | 135 (1.7) | 70 (2.2) | 0.002 | 59 (0.7) | 74 (1.2) | 115 (2.3) | 0.008 | 39 (0.4) | 79 (1.3) | 130 (2.5) | |
PFAS excluding PFOA (exposure) | |||||||||||||
Low | 4,160 (36.2) | — | — | — | — | 2,802 (74.1) | 1,124 (32.7) | 234 (5.9) | — | — | — | — | |
Medium | 5,327 (44.0) | — | — | — | — | 808 (19.6) | 2,113 (52.5) | 2,406 (57.9) | — | — | — | — | |
High | 2,260 (19.8) | — | — | — | — | 303 (6.3) | 605 (14.8) | 1,352 (36.2) | — | — | — | — | |
PFAS excluding PFOS (exposure) | |||||||||||||
Low | 4,133 (35.4) | — | — | — | — | — | — | — | — | 3,028 (76.6) | 979 (23.3) | 126 (2.9) | |
Medium | 5,180 (42.7) | — | — | — | — | — | — | — | — | 666 (18.3) | 2,076 (52.9) | 2,438 (58.5) | |
High | 2,434 (21.9) | — | — | — | — | — | — | — | — | 192 (5.1) | 862 (23.8) | 1,380 (38.5) | |
Sex | |||||||||||||
Male | 5,681 (48.5) | 1,401 (36.4) | 2,924 (53.7) | 1,356 (56.6) | 1,391 (34.8) | 1,927 (50.1) | 2,363 (59.3) | 1,382 (35.2) | 1,918 (50.3) | 2,381 (61.3) | |||
Female | 6,066 (51.5) | 2,512 (63.6) | 987 (46.3) | 2,567 (43.4) | 2,522 (65.2) | 1,915 (49.9) | 1,629 (40.7) | 2,504 (64.8) | 1,999 (49.7) | 1,563 (38.7) | |||
Age (y)a | 42.5 | 39.6 | 43.2 | 45.7 | 40.3 | 43.2 | 43.8 | 39.3 | 42.6 | 46.2 | |||
Race/ethnicity | |||||||||||||
Non-Hispanic White | 5,274 (69.4) | 1,426 (60.8) | 2,877 (77.0) | 971 (66.5) | 1,357 (58.3) | 1,722 (71.1) | 2,195 (77.9) | 1,527 (63.1) | 1,794 (71.8) | 1,953 (73.9) | |||
Non-Hispanic Black | 2,427 (10.8) | 730 (11.1) | 1,002 (9.1) | 695 (14.2) | 0.001 | 852 (13.3) | 782 (10.6) | 793 (8.8) | 0.005 | 674 (10.0) | 761 (10.1) | 992 (12.4) | 0.148 |
Mexican American | 2,219 (8.5) | 895 (13.1) | 1,111 (6.9) | 213 (4.4) | 875 (12.7) | 776 (8.2) | 568 (4.9) | 821 (12.2) | 788 (8.3) | 610 (4.6) | |||
Other | 1,827 (11.3) | 862 (14.9) | 501 (7.0) | 464 (14.9) | 829 (15.7) | 562 (10.1) | 436 (8.4) | 864 (14.7) | 574 (9.8) | 389 (9.1) | |||
Education | |||||||||||||
With high school education | 5,266 (56.1) | 1,790 (56.3) | 2,346 (54.8) | 1,130 (58.6) | 0.225 | 1,703 (54.5) | 1,765 (57.6) | 1,798 (56.3) | 0.374 | 1,814 (57.0) | 1,804 (57.5) | 1,648 (53.4) | 0.131 |
Without high school education | 5,606 (40.2) | 1,828 (39.3) | 2,648 (41.2) | 1,130 (39.5) | 0.635 | 1,927 (41.1) | 1,780 (38.8) | 1,899 (40.6) | 0.544 | 1,772 (38.5) | 1,813 (38.8) | 2,021 (43.7) | 0.029 |
Missing | 875 (3.7) | 295 (4.4) | 497 (4.0) | 83 (1.8) | 0.004 | 283 (4.4) | 297 (3.6) | 295 (3.1) | 0.299 | 300 (7.5) | 300 (7.2) | 275 (7.6) | 0.939 |
Income | |||||||||||||
8,443 (80.7) | 2,826 (79.7) | 3,863 (80.2) | 1,754 (83.5) | 0.062 | 2,785 (78.9) | 2,718 (80.3) | 2,940 (82.7) | 0.094 | 2,811 (79.0) | 2,828 (82.0) | 2,804 (81.1) | 0.218 | |
2,654 (15.3) | 874 (16.0) | 1,318 (16.0) | 462 (12.7) | 0.057 | 926 (17.4) | 890 (15.1) | 838 (13.8) | 0.078 | 868 (16.7) | 892 (14.7) | 894 (14.6) | 0.339 | |
Missing | 650 (3.9) | 213 (4.3) | 310 (3.8) | 127 (3.8) | 0.803 | 202 (3.8) | 234 (4.6) | 214 (3.5) | 0.428 | 207 (4.3) | 197 (3.3) | 246 (4.3) | 0.417 |
Smoking status | |||||||||||||
Never | 5,989 (52.4) | 2,211 (57.2) | 2,557 (48.3) | 1,221 (53.7) | 2,242 (57.8) | 1,881 (51.0) | 1,866 (48.9) | 2,152 (55.9) | 1,985 (52.3) | 1,852 (48.7) | 0.005 | ||
Former smoker | 2,739 (23.5) | 753 (20.0) | 1,354 (25.0) | 632 (26.0) | 0.003 | 776 (19.7) | 938 (25.0) | 1,025 (25.6) | 0.003 | 713 (19.2) | 935 (24.3) | 1,091 (27.5) | |
Current smoker | 2,264 (21.0) | 749 (20.1) | 1,101 (22.9) | 414 (18.6) | 0.054 | 699 (19.6) | 753 (20.9) | 812 (22.4) | 0.306 | 819 (22.2) | 715 (19.9) | 730 (21.0) | 0.451 |
Missing | 755 (3.0) | 200 (2.7) | 479 (3.8) | 76 (1.7) | 0.016 | 196 (2.8) | 270 (3.1) | 289 (3.0) | 0.922 | 202 (2.7) | 282 (3.4) | 271 (2.7) | 0.563 |
Alcohol intake (d/wk) | |||||||||||||
5,594 (47.4) | 1,904 (49.7) | 2,675 (48.3) | 1,015 (41.4) | 1,900 (49.1) | 1,856 (47.8) | 1,838 (45.4) | 0.243 | 1,844 (49.2) | 1,868 (47.9) | 1,882 (44.6) | 0.409 | ||
3,011 (32.2) | 863 (27.9) | 1,410 (32.6) | 738 (38.1) | 811 (26.1) | 992 (33.1) | 1,208 (36.6) | 968 (31.4) | 995 (32.6) | 1,048 (32.8) | 0.769 | |||
Missing | 3,142 (20.5) | 1,146 (22.4) | 1,406 (19.0) | 590 (20.5) | 0.170 | 1,202 (24.8) | 994 (19.0) | 946 (18.0) | 1,074 (19.4) | 1,054 (19.5) | 1,014 (22.6) | 0.237 | |
Physical activity (times/month) | |||||||||||||
1,789 (15.7) | 218 (4.9) | 1,234 (22.5) | 337 (17.9) | 297 (6.9) | 555 (13.9) | 937 (25.0) | 167 (3.5) | 539 (14.4) | 1,083 (30.7) | ||||
1,115 (9.4) | 148 (3.4) | 750 (12.9) | 217 (11.7) | 218 (5.3) | 356 (8.9) | 541 (13.6) | 114 (2.8) | 350 (8.9) | 651 (17.5) | ||||
Missing | 8,843 (74.9) | 3,547 (91.7) | 3,507 (64.6) | 1,789 (70.4) | 3,398 (87.8) | 2,931 (77.1) | 2,514 (61.4) | 3,605 (93.7) | 3,028 (76.7) | 2,210 (51.8) | |||
Hypertension | |||||||||||||
With | 2,088 (14.8) | 528 (12.2) | 1,075 (16.1) | 485 (16.1) | 0.018 | 568 (12.2) | 714 (15.4) | 806 (16.5) | 0.019 | 3,223 (11.6) | 3,085 (14.4) | 2,862 (18.8) | |
Without | 9,170 (81.2) | 3,219 (83.8) | 4,207 (80.1) | 1,744 (79.2) | 0.021 | 3,150 (83.2) | 2,988 (81.0) | 3,032 (79.5) | 0.103 | 503 (84.4) | 679 (82.0) | 906 (76.6) | |
Missing | 489 (4.1) | 166 (4.0) | 209 (3.8) | 114 (4.7) | 0.572 | 195 (4.6) | 140 (3.6) | 154 (3.9) | 0.506 | 160 (4.0) | 154 (3.7) | 175 (4.6) | 0.586 |
Diabetes | |||||||||||||
With | 1,282 (8.8) | 438 (9.6) | 575 (8.3) | 269 (8.4) | 0.520 | 501 (10.6) | 429 (9.1) | 352 (6.7) | 0.008 | 400 (9.1) | 434 (8.3) | 448 (8.9) | 0.805 |
Without | 10,236 (89.5) | 3,397 (88.3) | 4,822 (90.3) | 2,017 (89.7) | 0.328 | 3,339 (87.6) | 3,336 (88.9) | 3,561 (91.8) | 0.070 | 3,415 (89.1) | 3,406 (90.1) | 3,415 (89.3) | 0.742 |
Missing | 229 (1.7) | 78 (2.1) | 93 (1.4) | 57 (1.9) | 0.479 | 73 (1.8) | 77 (1.9) | 79 (1.5) | 0.775 | 71 (1.8) | 77 (1.6) | 81 (1.8) | 0.925 |
Healthy eating index (tertile) | |||||||||||||
First | 2,332 (18.9) | 594 (14.2) | 1,179 (20.5) | 559 (22.9) | 694 (17.0) | 723 (17.7) | 915 (22.0) | 0.008 | 636 (15.6) | 764 (19.4) | 932 (22.7) | ||
Second | 2,350 (18.9) | 846 (20.5) | 1,081 (18.6) | 423 (17.2) | 0.531 | 834 (20.4) | 779 (19.5) | 737 (17.7) | 0.296 | 898 (22.2) | 776 (18.7) | 676 (16.1) | 0.002 |
Third | 2,344 (18.9) | 930 (22.6) | 1,094 (19.0) | 320 (12.7) | 835 (20.1) | 869 (21.5) | 640 (15.0) | 842 (20.7) | 795 (17.8) | 707 (17.1) | 0.089 | ||
Missing | 4,721 (43.2) | 1,543 (42.7) | 2,137 (41.9) | 1,041 (47.2) | 0.036 | 1,550 (42.5) | 1,471 (41.3) | 1,700 (45.3) | 0.179 | 1,510 (41.5) | 1,582 (44.1) | 1,629 (44.1) | 0.399 |
BMI () | |||||||||||||
Normal () | 3,672 (31.9) | 1,166 (30.1) | 1,746 (32.3) | 760 (33.9) | 0.188 | 1,224 (31.4) | 1,221 (32.7) | 1,227 (31.6) | 0.798 | 1,228 (32.5) | 1,236 (32.7) | 1,208 (30.2) | 0.411 |
Overweight (25.0–29.9) | 3,867 (33.4) | 1,191 (30.0) | 1,855 (34.7) | 821 (36.1) | 0.011 | 1,190 (30.9) | 1,274 (33.3) | 1,403 (35.5) | 0.090 | 1,175 (30.8) | 1,310 (34.4) | 1,382 (35.2) | 0.080 |
Obese () | 4,039 (33.5) | 1,482 (38.3) | 1,819 (32.0) | 738 (29.3) | 1,411 (35.6) | 1,303 (33.0) | 1,325 (32.2) | 0.243 | 1,416 (35.1) | 1,319 (31.9) | 1,304 (33.6) | 0.317 | |
Missing | 169 (1.2) | 74 (1.7) | 71 (1.0) | 24 (0.7) | 0.095 | 88 (2.0) | 44 (0.9) | 37 (0.7) | 0.016 | 67 (1.6) | 52 (1.0) | 50 (0.9) | 0.288 |
Ccr (mL/min) | |||||||||||||
9,826 (87.2) | 3,431 (89.9) | 4,505 (86.0) | 1,890 (85.5) | 0.006 | 3,319 (87.9) | 3,222 (87.3) | 3,285 (86.5) | 0.642 | 3,425 (90.0) | 3,282 (87.7) | 3,119 (83.5) | ||
50–70 | 1,101 (7.6) | 238 (5.1) | 582 (8.6) | 281 (9.6) | 295 (5.9) | 372 (8.3) | 434 (8.6) | 0.044 | 237 (5.4) | 377 (7.6) | 487 (10.2) | ||
30–49.9 | 543 (3.3) | 122 (2.5) | 290 (3.8) | 131 (3.7) | 0.197 | 151 (3.1) | 183 (3.2) | 209 (3.7) | 0.726 | 111 (2.3) | 177 (3.2) | 255 (4.7) | 0.011 |
126 (0.7) | 60 (1.0) | 47 (0.6) |
19 (0.4) |
0.244 | 69 (1.2) | 28 (0.5) | 29 (0.4) | 0.065 | 55 (0.9) | 33 (0.6) | 38 (0.6) | 0.649 | |
Missing | 151 (1.2) | 62 (1.5) | 67 (1.1) | 22 (0.7) | 0.230 | 79 (1.9) | 37 (0.8) | 35 (0.8) | 0.030 | 58 (1.4) | 48 (1.0) | 45 (1.1) | 0.687 |
Total cholesterol (mg/dL) | |||||||||||||
Concentrationa,b | 11,744 (191.2) | 3,912 (186.9) | 5,489 (192.3) | 2,343 (195.9) | 3,912 (185.9) | 3,842 (191.4) | 3,990 (195.7) | 3,886 (187.3) | 3,916 (189.7) | 3,942 (197.3) | |||
Missing | 3 (—) | 1 (—) | 2 (—) | 0 (—) | — | 1 (—) | 0 (—) | 2 (—) | — | 0 (—) | 1 (—) | 2 (—) | — |
Serum cotinine (ng/dL) | |||||||||||||
Concentrationa,b | 11,705 (0.37) | 3,907 (0.26) | 5,457 (0.50) | 2,341 (0.32) | 3,901 (0.26) | 3,835 (0.35) | 3,969 (0.53) | 3,882 (0.32) | 3,912 (0.34) | 3,911 (0.48) | |||
Missing | 42 (—) | 6 (—) | 34 (—) | 2 (—) | — | 12 (—) | 7 (—) | 23 (—) | — | 4 (—) | 5 (—) | 33 (—) | — |
Note: Percentages, means, and cut points were weight-adjusted using NHANES-specified sampling weights. For categorical variables, -values were calculated using chi-square test, and for continuous variables, -values were calculated using one-way ANOVA (normal distribution) or Kruskal–Wallis H test (non-normal distribution). Samples with test values below the LOQ were substituted with the value of the LOQ divided by the square root of 2. —, not applicable; ANOVA, analysis of variance; BMI, body mass index; Ccr, creatinine clearance rate; GM, geometric mean; LOQ, limit of quantification; NHANES, National Health and Nutrition Examination Survey; PFAS, per- and polyfluoroalkyl substances; PFOA, perfluorooctanoic acid; PFOS, perfluorooctane sulfonic acid.
aAge, total cholesterol, and cotinine were treated as continuous variables.
bNon-normal distribution data presented as GMs.