B-281 Correlation Between PFAS Forever Chemical Concentrations in Remnant Serum and Public Drinking Water

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Abstract Background Per- and poly-fluoroalkyl substances (PFAS) are a growing public health concern, as they are widely used in industry and consumer products and some studies have shown associations between high PFAS exposure and adverse health effects. EPA monitors PFAS in public water systems (PWS) with the unregulated contaminant monitoring rule (UCMR). The National Academies of Science, Engineering, and Medicine (NASEM) published clinical and laboratory direction that 9 PFAS should be measured in serum and a summed total PFAS used to guide clinical care based on two categories: usual standard of care appropriate for age for most individuals at = 20 ng/mL summed PFAS; and additional testing, follow-up and further exposure reduction for individuals with a PFAS sum >20 ng/mL who may be at increased risk of PFAS-related adverse health effects. To better understand the correlation between PFAS contamination in drinking water and PFAS in serum in clinical populations, a prospective study was conducted with specimens collected from zip codes with low and high PFAS exposure. Methods Zip codes with low PFAS exposure were identified from PWS IDs in UCMR3 and UCMR5 with all measured PFAS below minimum reporting levels (MRLs). Zip codes with high PFAS exposure were determined by identifying the 25 PWS IDs with the highest individual and summed PFOS, PFOA, and PFHxS in UCMR5 data available as of April 2024. After removing duplicates, checking remnant specimen availability and pairing zip codes for low- and high-exposure groups by state, 20 unique paired PWS ID sets were finalized and used to pull random remnant specimens. With IRB approval, all remnant specimens were deidentified and tested using a recent published method for serum PFAS quantitation of the 9 NASEM-recommended analytes. Wilcoxon rank test and Chi-Square test were used to compare numeric PFAS (summation and individual) and categorical PFAS summation respectively. Results A total of 1,599 remnant specimens were received and tested: 771 in the high-exposure group and 788 specimens in the low-exposure group. Two groups were comparable in sex distribution (high group: female 56.7% and male 43.3%, low group: female 58.4% and male 41.6%) and mean age (high group: 52.0 y/o, low group: 51.1 y/o) (both p>0.4). Mean PFAS summation was 9.2 ng/mL in the high group comparing to 6.1 ng/mL in the low group (p<0.001). Categorically the percentage of people with PFAS summation >20 ng/mL in the high group was 7.1%, which was also significantly higher than 2.8% observed in the low group (p<0.001). Similarly, mean individual PFAS was higher in the high group comparing to the low group for PFOS (3.0 ng/mL vs. 2.2 ng/mL), PFOA (1.6 ng/mL vs. 0.9 ng/mL), and PFHxS (2.0 ng/mL vs. 1.1 ng/mL) (all p<0.001). Conclusion This PFAS study of remnant specimens supports the hypothesis that higher PFAS contamination in public drinking water is associated with higher PFAS serum concentrations in exposed communities. This study supports policies encouraging PFAS testing and treatment at public water systems to reduce potential health effects. Further studies on these remnant specimens will investigate correlations to clinical outcomes.

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