Exposure to Perfluoroalkyl Substances and Mortality for COVID-19: A Spatial Ecological Analysis in the Veneto Region (Italy)

Dolores Catelan, Annibale Biggeri, Francesca Russo, Dario Gregori, Gisella Pitter, Filippo Da Re, Tony Fletcher and Cristina Canova
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Dolores Catelan: Department of Statistics, Computer Science, Applications ‘G. Parenti’ (DiSIA), University of Florence, 50134 Firenze, Italy
Annibale Biggeri: Department of Statistics, Computer Science, Applications ‘G. Parenti’ (DiSIA), University of Florence, 50134 Firenze, Italy
Francesca Russo: Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, 30123 Venice, Italy
Dario Gregori: Unit of Biostatistics, Epidemiology and Public Health, Department of Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
Gisella Pitter: Screening and Health Impact Assessment Unit, Azienda Zero, Regione del Veneto, 35131 Padova, Italy
Filippo Da Re: Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, 30123 Venice, Italy
Tony Fletcher: Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
Cristina Canova: Unit of Biostatistics, Epidemiology and Public Health, Department of Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy

IJERPH, 2021, vol. 18, issue 5, 1-11

Abstract: Background: In the context of the COVID-19 pandemic, there is interest in assessing if per- and polyfluoroalkyl substances (PFAS) exposures are associated with any increased risk of COVID-19 or its severity, given the evidence of immunosuppression by some PFAS. The objective of this paper is to evaluate at the ecological level if a large area (Red Zone) of the Veneto Region, where residents were exposed for decades to drinking water contaminated by PFAS, showed higher mortality for COVID-19 than the rest of the region. Methods: We fitted a Bayesian ecological regression model with spatially and not spatially structured random components on COVID-19 mortality at the municipality level (period between 21 February and 15 April 2020). The model included education score, background all-cause mortality (for the years 2015–2019), and an indicator for the Red Zone. The two random components are intended to adjust for potential hidden confounders. Results: The COVID-19 crude mortality rate ratio for the Red Zone was 1.55 (90% Confidence Interval 1.25; 1.92). From the Bayesian ecological regression model adjusted for education level and baseline all-cause mortality, the rate ratio for the Red Zone was 1.60 (90% Credibility Interval 0.94; 2.51). Conclusion: In conclusion, we observed a higher mortality risk for COVID-19 in a population heavily exposed to PFAS, which was possibly explained by PFAS immunosuppression, bioaccumulation in lung tissue, or pre-existing disease being related to PFAS.

Keywords: PFAS; COVID-19 mortality; ecological analysis; epidemiological surveillance; hierarchical Bayesian models (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (4)

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