PFAS Health Study Component three: Cross-sectional survey of self-reported physical and mental health outcomes and associations with blood serum PFAS December 2021
Creators: name: Lazarevic, Nina
name: Smurthwaite, Kayla
name: Trevenar, Susan
name: D'Este, Catherine
name: Batterham, Philip
name: Lane, Jo
name: Armstrong, Bruce
name: Lucas, Robyn
name: Clements, Archie
name: Banwell, Cathy
name: Hosking, Rose
name: Joshy, Amelia
name: Gad, Imogen
name: Law, Hsei Di
name: Mueller, Jochen
name: Bräunig, Jennifer
name: Nilsson, Sandra
name: Lal, Aparna
name: Randall, Deborah
name: Miller, Adrian
name: Korda, Rosemary
name: Kirk, Martyn
Publisher: name: National Centre for Epidemiology and Population Health, The Australian National University
Year: 2021

description: Per- and polyfluoroalkyl substances (PFAS) are man-made chemicals that may be harmful to the environment and human health. The aim of the PFAS Health Study Cross-sectional Survey was to examine health conditions and concerns among people who had lived or worked in Australian communities with known PFAS contamination. This included Katherine in the Northern Territory, Oakey in Queensland, and Williamtown in New South Wales (the ‘exposed communities’). We surveyed people in these communities who provided a blood sample for PFAS testing in the Australian Government-funded Voluntary Blood Testing Program. We also surveyed people in similar communities in Australia not known to have PFAS contamination. This included Alice Springs in the Northern Territory, Dalby in Queensland, and Kiama and Shellharbour in New South Wales (the ‘comparison communities’). We did this through Services Australia, who sent invitations to a random sample of people on the Medicare Enrolment File in the comparison communities, on behalf of the PFAS Health Study team. We asked people in exposed and comparison communities to complete an online or paper survey that asked about their demographic details; where they had lived and worked; whether they had ever been diagnosed with any of 32 health conditions; and the state of their mental health. We also asked people in exposed communities about their health concerns and use of healthcare related to the PFAS contamination. We measured levels of PFAS in blood to see how health conditions varied with different levels of PFAS. We focused on three PFAS that were found in the blood of most participants in the exposed communities: perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonic acid (PFHxS). In total, 917 people from the exposed communities and 801 from the comparison communities completed the survey. We compared the percentage of people with different health conditions in the exposed and comparison communities. People in Katherine were more likely to report cancer (especially breast cancer) and liver disease (especially fatty liver disease) than people in Alice Springs. In Williamtown, people were more likely to report rheumatoid arthritis, hypercholesterolaemia (high cholesterol), type II diabetes, and problems with fertility compared to people in Kiama and Shellharbour. In Oakey and Dalby, the numbers of people surveyed were too small to make reliable comparisons. While we observed differences between exposed and comparison communities, the findings were not consistent across exposed and comparison community pairs. The reported health conditions could have occurred at any time, even before a person lived or worked in a community exposed to PFAS. In addition, health conditions were self-reported by survey participants and may not have been diagnosed by a health professional. We found that people with higher PFAS levels were not more likely to report most diseases. However, the results varied across the different communities and PFAS. For example, for a doubling of the blood level of PFOS, people in Katherine were 29% less likely to report breast cancer, whereas in Williamtown people were 15% more likely to report breast cancer. For one chemical, PFOA, which was not elevated in people in exposed communities compared to people in comparison communities in the PFAS Health Study Blood Serum Study, we found that a doubling of blood levels was associated with more people with high cholesterol, gout, and hypothyroidism in different exposed communities. People living in exposed communities reported much higher levels of mental distress and worry than people in comparison communities. People who worked with firefighting foams containing PFAS and people who used bore water on their properties reported higher levels of worry and concern than people who did not. In the exposed communities, one in three people reported being ‘very’ or ‘extremely’ concerned about their health and one in five people had serious concerns about their mental health. People surveyed in these communities also reported concerns about their finances, the stigma of living in exposed communities, and uncertainty about the future. The survey participants from the exposed communities were not randomly sampled, rather people chose to participate. The results may therefore represent the experiences of people who were more worried about PFAS or were more likely to believe an illness was related to PFAS because of their known exposure. The results may not represent the experience of all people living in the communities. In the comparison communities, we randomly sampled people, but a very small number of the invited people completed the survey (only 3%). In addition, some of the reported results could be due to chance. Because this is a cross-sectional survey, we cannot draw conclusions about whether PFAS could have caused health conditions. While survey participants reported higher percentages of some health conditions in individual communities, these findings were not consistent across communities, and were not clearly related to levels of PFAS in blood. In contrast, there was consistency when looking at mental health. We observed higher levels of distress and worry in people from exposed communities, particularly among those who may have been exposed to PFAS at work, than in people from comparison communities.