Drinking Water Contamination from Perfluoroalkyl Substances (PFAS): an Ecological Mortality Study in the Veneto Region, Italy
Open accessAbstract
Background: Perfluoroalkyl substances (PFAS), a heterogeneous group of highly stable man-made chemicals, have been widely used since 1960s and can be detected almost ubiquitously in all environmental matrices. In Italy, on January 2014, drinking water contamination in an area of the Veneto Region was detected mainly due to the drain of fluorinated chemicals by a manufacturing company operating since 1964. Methods: The present ecological mortality study was aimed at comparing mortality for some causes of death selected on the basis of previous reported associations, during the period 1980-2013, in municipalities with PFAS contaminated and uncontaminated drinking water on the basis of the levels indicated by the Italian National Health Institute (ISS). Sex-specific number, standardized mortality rates and rate ratios (RR) for PFAS contaminated and uncontaminated areas were computed for each cause of death through the ENEA epidemiological database. Results: In both sexes, statistically significant RRs were detected for all causes mortality, diabetes, cerebrovascular diseases, myocardial infarction and Alzheimer's disease. In females, RRs significantly higher than 1.0 were also observed for kidney and breast cancer, and Parkinson's disease. Increased risk, although not statistically significant, was observed for bladder cancer in both sexes, and for testicular cancer, pancreatic cancer and leukemia in males only. Conclusions: Higher mortality levels for some causes of death, possibly associated with PFAS exposure, were detected in contaminated municipalities in comparison with uncontaminated ones with similar socioeconomic status and smoking habits. These results warrant further individual level analytic studies to delineate casual associations.
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PFAS exposure has been associated with increased risk of Alzheimer's disease.
“a neuropathology frequently observed in progressive diseases like Alzheimer’s, for which PFAS exposure has been associated with increased risk (Mastrantonio et al., 2018).”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Mastrantonio et al., 2018
The Results report significantly higher Alzheimer’s disease mortality in PFAS-contaminated municipalities than in uncontaminated municipalities (relative risks 1.33 for males and 1.35 for females). This supports an ecological association, but the citing sentence presents it as a general association between PFAS exposure and risk of developing Alzheimer’s disease; the study measured mortality by municipality, not individual exposure or disease incidence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThree different studies have reported increased diabetes-driven mortality in populations exposed to high concentrations of PFAS, including individuals with contaminated drinking water and fluorochemical factory workers.
“Three different studies have reported increased diabetes driven mortality in populations exposed to high concentrations of PFAS, including individuals with contaminated drinking water and fluorochemical factory workers”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Mastrantonio et al., 2018
The Results (page unavailable) report significantly higher diabetes mortality in municipalities with PFAS-contaminated drinking water. The Discussion (page unavailable) also reports a higher diabetes risk among PFOA production workers. Our copy does not establish that three different studies reported increased diabetes mortality, or that exposure concentrations were high in each population. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOne epidemiological study found a positive correlation between high PFAS concentrations in drinking water and relative risk for AD in deceased subjects of both sexes, and PD in females only.
“one epidemiological study found a positive correlation between high PFAS concentrations in participant’s drinking water and relative risk for AD in deceased subjects of both sexes, and PD in females only (Mastrantonio et al., 2018).”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Mastrantonio et al., 2018
The Results report higher Alzheimer’s disease mortality rate ratios in males and females and a significantly higher Parkinson’s disease ratio in females. However, the Methods describe an ecological comparison of municipalities with contaminated versus uncontaminated drinking water, not a correlation between measured PFAS concentrations in individual participants’ water and their risk. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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- Authors
- Mastrantonio, M., Bai, E., Uccelli, R., Cordiano, V., Screpanti, A., & Crosignani, P.
- Affiliations
- National Agency for New Technologies, Energy and Sustainable Economic Development (IT)
- Corresponding author
- Mastrantonio, Marina
- Venue
- European Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-23
- Volume
- 28
- Issue
- 1
- Pages
- 180-185
- ISSN
- 1101-1262 (ISSN-L)
- 1464-360X
- OpenAlex
- W2617249117
- Cited by
- 228
- References
- 35
- Citations by year
- 2026: 30 · 2025: 37 · 2024: 45 · 2023: 34 · 2022: 36 · 2021: 13 · 2020: 25 · 2019: 5 · 2018: 3
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- ENEA Open Archive (National Agency for New Technologies, Energy and Sustainable Economic Development) (submittedVersion)
- Funders
- Innovation, Science and Economic Development Canada
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Physical Sciences › Environmental Science › Water Science and Technology › Fluoride Effects and Removal
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
- Keywords
- perfluorinated compounds, PFAS, drinking water contamination, cause-specific mortality, fluorinated compounds, industrial pollution, diabetes mellitus, cerebrovascular disease, myocardial infarction, Alzheimer's disease, Parkinson's disease, cancer mortality, Veneto
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Cities, Death, Environmental Monitoring, Female, Fluorocarbons, Humans, Infant, Italy, Male, Middle Aged, Water Pollutants, Chemical, Water Pollution, Age Distribution, Young Adult, Drinking Water
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