Exposure to Perfluoroalkyl Substances and Mortality for COVID-19: A Spatial Ecological Analysis in the Veneto Region (Italy)
Open accessAbstract
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.
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PFAS exposure may leave the brain vulnerable to the deleterious impacts of infections, such as COVID-19, through attenuation of the adaptive immune system.
“PFAS exposure may also leave the brain vulnerable to the deleterious impacts of infections, such as COVID-19 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), through attenuation of the adaptive immune system”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Catelan et al., 2021
The Introduction describes evidence that some PFAS impair antibody responses and proposes that PFAS immunotoxicity could worsen COVID-19. The Conclusions likewise offer immunosuppression as a possible explanation for higher COVID-19 mortality in a heavily exposed population. Neither passage addresses brain vulnerability or neurological impacts of infection. (LLM, conf=0.88)
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- Authors
- Catelan, D., Biggeri, A., Russo, F., Gregori, D., Pitter, G., Da Re, F., Fletcher, T., & Canova, C.
- Affiliations
- University of Florence (IT)
- Regione del Veneto (IT)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy
- Regional Directorate of Prevention, Food Safety, Veterinary Public Health, Regione del Veneto, 30123 Venice, Italy
- London School of Hygiene & Tropical Medicine (GB)
- University of Padua (IT)
- Corresponding author
- Canova, Cristina
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2021-03-08
- Volume
- 18
- Issue
- 5
- Pages
- 2734
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC7967461
- OpenAlex
- W3133988412
- Cited by
- 47
- References
- 28
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 12 · 2023: 8 · 2022: 12 · 2021: 4
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Florence Research (University of Florence) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, cc-by)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Physical Sciences › Environmental Science › Water Science and Technology › Fluoride Effects and Removal
- Keywords
- per- and polyfluoroalkyl substances, PFAS exposure, COVID-19 mortality, drinking water contamination, immunosuppression, Veneto, red zone, all-cause mortality, educational attainment
- MeSH terms
- COVID-19, SARS-CoV-2, Bayes Theorem, Cities, Fluorocarbons, Humans, Italy, Alkanesulfonic Acids, Pandemics
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