Table 4.
HRs (95% CIs) for PFAS (excluding PFOA) Mixture/PFAS (excluding PFOS) mixture exposure and mortality risk in the NHANES follow-up study from 1999–2014 to 31 December 2015 ().
| Categories | All-cause mortality | Heart disease mortality | Cancer mortality | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Deaths/observations () | Unadjusted HR | Adjusted HR | Deaths/observations () | Unadjusted HR | Adjusted HR | Deaths/observations () | Unadjusted HR | Adjusted HR | |
| PFAS excluding PFOA (exposure)a | |||||||||
| Low | 216/4,160 | Ref | Ref | 77/4,160 | Ref | Ref | 56/4,160 | Ref | Ref |
| Medium | 717/5,327 | 1.26 (1.08, 1.51) | 1.08 (0.84, 1.39) | 203/5,327 | 1.60 (1.15, 2.18) | 1.30 (0.88, 1.92) | 118/5,327 | 1.21 (0.77, 1.93) | 1.08 (0.68, 1.83) |
| High | 318/2,260 | 1.63 (1.30, 1.99) | 1.40 (1.08, 1.86) | 92/2,260 | 1.73 (1.25, 2.33) | 1.54 (1.03, 2.32) | 74/2,260 | 1.93 (1.27, 3.05) | 1.68 (1.06, 2.89) |
| PFAS excluding PFOS (exposure)b | |||||||||
| Low | 375/4,133 | Ref | Ref | 104/4,133 | Ref | Ref | 75/4,133 | Ref | Ref |
| Medium | 653/5,180 | 1.34 (1.09, 1.64) | 1.11 (0.90, 1.44) | 191/5,180 | 1.40 (1.05, 1.97) | 1.16 (0.79, 1.69) | 116/5,180 | 1.01 (0.65, 1.60) | 0.86 (0.53, 1.36) |
| High | 223/2,434 | 1.04 (0.88, 1.24) | 0.86 (0.65, 1.13) | 77/2,434 | 1.25 (0.90, 1.76) | 1.08 (0.69, 1.80) | 57/2,434 | 1.04 (0.70, 1.63) | 0.93 (0.55, 1.57) |
Note: HRs were estimated using Cox proportional hazards models and were weight adjusted using NHANES-specified sampling weights. Missing data on covariates were processed using multiple imputation algorithm. Samples with test values below the LOQ were substituted with the value of the LOQ divided by the square root of 2. BMI, body mass index; Ccr, creatinine clearance rate; CI, confidence interval; HR, hazard ratio; LOQ, limit of quantification; NHANES, National Health and Nutrition Examination Survey; PFAS, per- and polyfluoroalkyl substances; PFOA, perfluorooctanoic acid; PFOS, perfluorooctane sulfonic acid; Ref, reference.
HRs were adjusted for sex, age, race/ethnicity, smoking status, alcohol intake, physical activity, hypertension, BMI, Ccr, serum total cholesterol, serum cotinine, and serum PFOA concentrations (categorized into three groups based on tertiles).
HRs were adjusted for sex, age, race/ethnicity, family income, smoking status, alcohol intake, physical activity, hypertension, BMI, Ccr, serum total cholesterol, serum cotinine, and serum PFOS concentrations (categorized into three groups based on tertiles).