Abstract
-
Background
Perfluoroalkyl substances (PFAS) are used in various products, and PFAS have been detected in outdoor clothing. PFAS can be absorbed into the human body via oral ingestion, inhalation, and dermal contact. In this study, we examined the association between the frequency of using outdoor clothing and serum PFAS concentrations in the Korean population using data from cycle 4 (2018–2020) of the Korean National Environmental Health Survey.
-
Methods
Data from 2,993 adult participants were analyzed. The participants were classified into low-concentration and high-concentration groups based on the 75th percentile concentration of serum PFAS. The use of outdoor clothing was categorized into three groups: non-use, <4 times a week, and ≥4 times a week. The odds ratio (OR) for serum PFAS levels associated with use of outdoor clothing was determined through logistic regression analysis, adjusted for demographic characteristics, health-related factors, PFAS-treated items, dietary factors, and ventilation time.
-
Results
ORs for high serum PFAS were higher in groups using outdoor clothing compared to the non-user group. In males, the adjusted ORs for the < 4 times a week and ≥ 4 times a week outdoor clothing usage group were as follows: perfluorooctanoic acid (PFOA), 1.26 (95% confidence interval [CI]: 1.10–1.44) and 1.70 (1.40–2.07); perfluorohexanesulfonic acid (PFHxS), 1.49 (1.16–1.92) and 1.70 (1.22–2.37); and perfluorononanoic acid (PFNA), 1.34 (1.19–1.51) and 1.68 (1.38–2.05), respectively. In females, the respective ORs were as follows: PFOA 1.32 (95% CI: 1.19–1.46) and 1.53 (1.01–2.32); PFHxS, 1.46 (1.08–1.96) and 2.63 (2.10–3.29); PFNA, 1.38 (1.22–1.55) and 1.45 (1.07–1.96).
-
Conclusions
In adults, elevated serum PFAS levels were associated with increased frequency of using outdoor clothing.
-
Keywords: Outdoor clothing; PFAS; Korean National Environmental Health Survey
BACKGROUND
Perfluoroalkyl substances (PFAS) are compounds in which fluorine atoms replace hydrogen atoms in the hydrocarbon chain. They are highly stable substances owing to the strong covalent bond between carbon and fluorine.
1 As PFAS are characterized by poor biodegradability and high persistence in living organisms, they can accumulate in the body over extended periods, potentially causing symptoms such as impairment of liver, kidney, and reproductive function.
2,3 PFAS have a hydrophilic head and a hydrophobic tail, making them resistant to both water and oil.
4 The surface tension of water and oil is reduced on surfaces coated with PFAS, imparting water-repellent and lipid-repellent effects.
5 These properties make PFAS suitable for use in a wide range of products, including outdoor clothing, food packaging, cookware, and furniture.
6
Outdoor clothing refers to garments designed for outdoor sports or leisure activities, including windbreakers, functional T-shirts, and hiking pants.
7 Previous studies have detected PFAS in outdoor clothing.
8,9 In South Korea, 70.9% of outdoor clothing buyers intend to use it for everyday wear.
10,11 As outdoor clothing is used for extended periods, not only during outdoor activities but also in daily life, it may result in continuous exposure to PFAS.
PFAS are absorbed into the human body through various routes, including oral ingestion, inhalation, and skin contact.
12,13 Previously, studies on human PFAS exposure have focused on dietary factors, with little research conducted on exposure from cloth wearing. To our knowledge, few studies have examined the association between the use of outdoor clothing and exposure to PFAS in South Korea. Therefore, this study aims to examine the association between the frequency of outdoor clothing use and serum PFAS in the Korean population using data from cycle 4 (2018–2020) of the Korean National Environmental Health Survey (KoNEHS).
METHODS
Study participants and data sources
This study analyzed data of adults aged 19 years and older who participated in cycle 4 of KoNEHS conducted by the National Institute of Environmental Research from 2018 to 2020. The KoNEHS, a nationwide statutory survey in accordance with the Environmental Health Act, has been conducted every three years since 2009. A total of 2,993 participants were included in the analysis (1,298 men and 1,695 women), after excluding 1,246 individuals without serum values from the original sample of 4,239 adults (
Fig. 1).
The KoNEHS measured five types of PFAS: perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDeA). Blood samples were processed to remove serum proteins; then, the serum PFAS contents were separated and quantitatively analyzed using the Q-sight Triple Quad high-performance liquid chromatography/mass spectrometer (PerkinElmer, Waltham, MA, USA). The limits of detection for the substances were as follows: PFOA, 0.071 μg/L; PFOS, 0.056 μg/L; PFHxS, 0.071 μg/L; PFNA, 0.019 μg/L; and PFDeA, 0.017 μg/L. The participants were divided into low-concentration and high-concentration groups based on the 75th percentile concentration of serum PFAS.
14
The KoNEHS survey categorized outdoor clothing use into seven categories: no use, once a month, two to three times a month, once a week, two to three times a week, four to six times a week, and every day. The participants were then divided into three groups: the participants who answered no use in the “no-use” group; those who used it once a month, two to three times a month, once a week, or two to three times a week were included in the “<4 times a week” group; and those who used it four to six times a week or daily were included in the “≥4 times a week” group.
Potential confounders
Age, body mass index (BMI), marital status, and smoking status were set as covariates for demographic characteristics and health-related characteristics, along with the use of PFAS-containing products, dietary factors, and ventilation time. The questionnaire for ventilation includes natural ventilation through windows and mechanical ventilation systems, such as air purifiers. Items containing PFAS included frying pans, pots, electric cookers, containers, coated agents or polish, as well as hiking boots. As dietary factors are a significant exposure pathway for PFAS, the frequency with which grilled fish, seaweed, and crustaceans are consumed, and the type of drinking water used, were considered.
15-18 In the KoNEHS, dietary factors were assessed using a frequency scale with the following categories: rarely, once a month, two to three times a month, once a week, two to three times a week, four to six times a week, once a day, twice a day, and three times a day. Responses of rarely, once a month, and two to three times a month were grouped as <once a week consumption, and those of once a week or more as ≥once a week consumption.
18 To account for potential exposure to PFAS in indoor environments, the average daily ventilation time in indoor spaces was also considered.
19
Independent t-tests and χ²-tests were performed to analyze the differences in distribution of variables, including demographic characteristics, health-related characteristics, outdoor clothing use, PFAS-containing products, dietary factors, ventilation time, and serum PFAS. The odds ratio (OR) for serum PFAS associated with outdoor clothing use was calculated using logistic regression analysis after adjusting for demographic characteristics, health-related characteristics, PFAS-containing items used, dietary factors, and ventilation time. The statistical analysis was performed using IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY, USA), and values with p-values <0.05 were considered statistically significant.
Ethics statement
This study received approval from the Institutional Review Board of Soonchunhyang University Gumi Hospital (IRB No.2025-09-02). All participants of the KoNEHS cycle 4 (2018–2020) included in this study provided written informed consent.
RESULTS
This study included 1,298 men (43%) and 1,695 women (57%). The average serum PFOA, PFOS, PFHxS, PFNA, and PFDeA concentrations were higher in men than in women. The average age of the participants was 47.4 years (men: 46.4 years, women: 48.5 years). Men were more likely to be overweight and smokers than women. Men were more likely to be in the ≥4 times a week outdoor clothing and hiking boots or sneakers usage group than women. Men had a higher proportion of using coated frying pans ≥4 times a week compared to women (
Table 1,
Supplementary Table 1).
The mean age was higher in the group with high concentrations of PFOA, PFOS, PFHxS, PFNA, and PFDeA. Among men, those in the ≥4 times a week group had the highest proportion of participants with high serum concentrations of PFOA, PFHxS, PFNA, and PFDeA. Among women, those in the ≥4 times a week group also showed the highest proportion of participants with high serum PFOA, PFOS, PFHxS, PFNA, and PFDeA. Among men, the non-user group of coated frying pans exhibited the lowest proportions of high serum concentrations of PFOA, PFOS, PFHxS, PFNA, and PFDeA than the user groups. Both men and women in groups using indoor and outdoor groundwater, simplified tap water, or tap water as their drinking water source showed a higher proportion of belonging to the high serum PFOA, PFOS, PFHxS, PFNA, and PFDeA groups compared to those using water purifiers or bottled water (
Tables 2–
5,
Supplementary Tables 2–
5).
Both men and women in the <4 times a week and ≥4 times a week outdoor clothing usage groups showed higher ORs for high PFOA, PFOS, PFHxS, PFNA, and PFDeA compared with the no-use group. Among men, the adjusted OR for high PFOA was 1.26 (95% confidence interval [CI]: 1.10–1.44) in the < 4 times a week outdoor clothing usage group and 1.70 (95% CI: 1.40–2.07) in the ≥ 4 times a week group. The adjusted ORs were 1.66 (95% CI: 1.47–1.89) and 1.57 (95% CI: 1.05–2.34) for high PFOS; 1.49 (95% CI: 1.16–1.92) and 1.70 (95% CI: 1.22–2.37) for high PFHxS; 1.34 (95% CI: 1.19–1.51) and 1.68 (95% CI: 1.38–2.05) for high PFNA; and 1.62 (95% CI: 1.16–2.27) and 1.79 (95% CI: 1.59–2.02) for high PFDeA. Among women, the adjusted OR for high PFOA was 1.32 (95% CI: 1.19–1.46) in the <4 times a week outdoor clothing usage group and 1.53 (95% CI: 1.01–2.32) in the ≥4 times a week group. The adjusted ORs were 1.16 (95% CI: 1.08–1.25) and 1.84 (95% CI: 1.45–2.34) for high PFOS; 1.46 (95% CI: 1.08–1.96) and 2.63 (95% CI: 2.10–3.29) for high PFHxS; 1.38 (95% CI: 1.22–1.55) and 1.45 (95% CI: 1.07–1.96) for high PFNA; and 1.47 (95% CI: 1.23–1.77) and 1.44 (95% CI: 1.35–1.52) for high PFDeA (
Table 6).
DISCUSSION
In this study, the adjusted OR for high serum PFAS levels was higher in the <4 times a week and ≥4 times a week outdoor clothing usage groups, compared to the no-use group. Particularly, when comparing <4 times a week and ≥4 times a week outdoor clothing usage groups, the ORs for PFOA, PFHxS, and PFNA were higher in the ≥4 times a week group, suggesting a dose-response relationship with increasing frequency of use. PFAS are referred to as “forever chemicals” because they have a long serum half-life in vivo of approximately 3.8–5.4 years and are bioaccumulative.
20 PFAS remain in the body bound to albumin, potentially causing immunosuppression, impaired liver function, and reduced reproductive function.
2,3,21 PFAS also act as endocrine disruptors and are associated with diabetes.
22 PFOA and PFOS have been associated with chronic kidney disease and kidney cancer.
23 PFNA are associated with birth weight deficits in newborns.
24 PFHxS are known to cause non-alcoholic fatty liver disease.
25 PFDeA is associated with hypertension.
26
PFAS are widely used in outdoor clothing for their waterproof and oil-repellent properties, and are also utilized in the manufacture of such garments in South Korea.
27 Previous studies have reported high concentrations of PFAS in outdoor clothing.
8,9 A previous study conducted by Greenpeace identified PFAS in 36 out of 40 products from 11 global outdoor brands, including Korean products. A total PFAS concentration of up to 730 μg/m² was detected in 36 outdoor products. The detected substances included PFOA, PFOS, PFHxS, PFNA, and PFDeA, which were the focus of this study.
9 PFAS used in outdoor clothing can detach from the fiber surface due to friction and ultraviolet exposure.
28 These released PFAS can then be absorbed into the human body through skin exposure, inhalation, and ingestion.
A significant route of exposure to PFAS when using outdoor clothing is through skin contact. The skin structure consists of a lipophilic skin membrane and a water-rich, hydrophilic epidermis and dermis.
29 PFAS exhibit greater lipophilicity with longer carbon-fluorine (CF) chains, and the PFOA, PFOS, PFHxS, PFNA, and PFDeA investigated in this study have long CF chains, resulting in strong lipophilicity.
30 These chemicals accumulate in the skin membrane, which is rich in lipids. The skin membrane acts as a reservoir for PFAS, enabling continuous permeation.
31 The permeated PFAS then gradually reaches the dermis through diffusion driven by the concentration gradient.
31,32 Subsequently, they circulate throughout the body via the blood vessels, binding to albumin in the blood.
Increased sweat secretion hydrates the stratum corneum, loosening the packing of intercellular lipids and increasing skin permeability beyond normal levels. Furthermore, continuous friction between the skin and clothing causes microdamage to the stratum corneum, increasing skin permeability.
32-34 Outdoor clothing frequently causes sweat secretion and friction because of the nature of activities in which it is used, causing a temporary increase in skin permeability and heightening the potential for PFAS exposure through the skin.
Experimental evidence supports dermal exposure to PFAS. In an in vitro study using 3D human skin equivalent models, most tested PFAS compounds showed measurable dermal absorption, and PFOA demonstrated substantial retention within skin tissue, reaching levels as high as 38%.
35 These findings suggest that PFAS can remain in the skin after contact, supporting the potential for long-term exposure with repeated wearing of outdoor clothing. This finding is consistent with our results, which showed higher ORs with more frequent outdoor clothing use.
Although some types of outdoor clothing, such as outer-layer jackets, have limited direct contact with the skin, exposure to PFAS may still occur through inhalation and ingestion pathways, particularly in indoor environments.
36,37 PFAS are classified into terminal PFAS, which do not break down in the body and accumulate as is, and precursor PFAS, which are metabolized and ultimately converted into terminal PFAS.
38 The PFOA, PFOS, PFHxS, PFNA, and PFDeA investigated in this study are classified as terminal PFAS. Owing to their low vapor pressure, these PFAS exhibit low volatility, which reduces their potential for inhalation exposure.
39 However, PFAS precursors are also commonly found in outdoor clothing. PFAS precursors are highly volatile and tend to vaporize, increasing their concentration in indoor air.
40 Studies measuring the concentration of PFAS precursors in indoor air revealed low levels below 1 ng/m³ in typical indoor spaces like offices and kitchens. Meanwhile, outdoor clothing stores exhibited the highest levels, reaching up to 285.8 ng/m³.
41 Therefore, inhalation of PFAS precursors released from outdoor clothing into indoor air may lead to their conversion within the body through oxidation processes into PFOA, PFOS, PFHxS, PFNA, PFDeA, and other compounds, potentially increasing serum PFAS.
42
Outdoor clothing use may expose individuals to PFAS not only through skin contact but also via oral ingestion.
13 If the bond with the fibers weakens, PFAS on clothing surfaces can transfer to hands or dust upon contact and be ingested.
43 According to prior studies on outdoor jackets, dust ingestion can account for approximately 30%–40% of total PFOA exposure.
44 These findings suggest that outdoor clothing can contribute to PFAS exposure through multiple pathways.
This study has some limitations. First, given its cross-sectional design, this study could not establish a causal relationship between outdoor clothing and serum PFAS. Second, as the survey was based on subjective reports, reporting and recall bias cannot be excluded. Third, although adjustments were made for drinking water intake and PFAS-related dietary factors, certain dietary items, such as pork offal and eggs, that have been reported to contain high levels of PFAS, were not included in this study. Finally, other important confounding variables not captured by the survey, such as single-use duration, contact area, occupational exposure, and additional unconsidered sources of PFAS exposure, may have influenced the findings.
To the best of our knowledge, South Korean studies on the association between outdoor clothing use and serum PFAS are insufficient. Therefore, despite the limitations of the study, its significance lies in its establishment of a correlation between outdoor clothing use and serum PFAS. This correlation is supported by data that is representative of the general population in South Korea, and it is further reinforced by extensive adjustments made for potential oral ingestion pathways. PFAS are substances that remain in the body for extended periods and exert various adverse effects on health. Therefore, exposure assessments for PFAS should also consider outdoor clothing use. The findings of this study can serve as a basis for future domestic PFAS safety management and the development of alternative materials.
CONCLUSIONS
This study examined the association between outdoor clothing use and serum PFAS in the general adult population of South Korea. Serum levels of PFAS (PFOA, PFOS, PFHxS, PFNA, and PFDeA) were elevated in adults who frequently used outdoor clothing.
Abbreviations
Korean National Environmental Health Survey
perfluoroalkyl substances
perfluorohexanesulfonic acid
perfluorooctanesulfonic acid.
NOTES
-
Funding
This research was supported by the Soonchunhyang University Research Fund.
-
Competing interests
The authors declare that they have no competing interests.
-
Author contributions
Conceptualization: Kim KW, Kang J. Data curation: Kim KW, Kang J. Formal analysis: Kim KW, Park HW. Methodology: Yoon S. Validation: Kim KW, Park HW, Kim D. Project administration: Cho SY. Funding acquisition: Kang J. Writing - original draft: Kim KW, Kang J. Writing - review & editing: Kim KW, Kang J, Cho SY, Yoon S, Kim D, Park HW.
-
Acknowledgments
This study used the Korean National Environmental Health Survey Cycle 4 (2018~2020), made by the National Institute of Environmental Research (NIER-2020-01-01-016). We appreciate the National Institute of Environmental Research for making the raw data of the Korean National Environmental Health Survey available.
SUPPLEMENTARY MATERIAL
Fig. 1.Participant selection flowchart. KoNEHS: Korean National Environmental Health Survey; PFAS: perfluoroalkyl substance.
Table 1.Baseline characteristics of the participants
|
Category |
Total (n = 2,993)a
|
Men (n = 1,298) |
Women (n = 1,695) |
p-value |
|
PFAS |
|
|
|
|
|
PFOA |
7.66 (7.33–8.00) |
7.99 (7.53–8.45) |
7.34 (7.13–7.55) |
<0.001b
|
|
PFOS |
18.87 (18.64–19.10) |
20.26 (19.53–20.98) |
17.48 (17.02–17.94) |
<0.001 |
|
PFHxS |
5.76 (5.39–6.12) |
6.42 (6.11–6.74) |
5.09 (4.68–5.50) |
<0.001 |
|
PFNA |
2.54 (2.52–2.57) |
2.73 (2.71–2.75) |
2.35 (2.32–2.39) |
<0.001 |
|
PFDeA |
1.08 (1.06–1.10) |
1.15 (1.13–1.17) |
1.01 (1.00–1.03) |
<0.001 |
|
Age (years) |
47.4 ± 0.13 |
46.4 ± 0.18 |
48.5 ± 0.10 |
<0.001 |
|
BMI (kg/m2) |
|
|
|
0.003c
|
|
≤25 |
1,577 (53.4) |
595 (46.1) |
982 (60.7) |
|
|
>25 |
1,416 (46.6) |
703 (53.9) |
713 (39.3) |
|
|
Outdoor clothing use |
|
|
|
0.001 |
|
None |
1,541 (52.3) |
557 (43.7) |
984 (60.8) |
|
|
<Four times a week |
1,002 (32.4) |
446 (33.9) |
556 (30.9) |
|
|
≥Four times a week |
450 (15.3) |
295 (22.4) |
155 (8.3) |
|
|
Coated frying pans use |
|
|
|
0.002 |
|
None |
83 (2.5) |
39 (2.6) |
44 (2.3) |
|
|
<Four times a week |
1,313 (40.1) |
557 (36.9) |
756 (43.2) |
|
|
≥Four times a week |
1,597 (57.4) |
702 (60.5) |
895 (54.4) |
|
|
Crustacean consumption |
|
|
|
0.076 |
|
<Once a week |
2,753 (91.8) |
1,189 (91.6) |
1,564 (92.1) |
|
|
≥Once a week |
240 (8.2) |
109 (8.4) |
131 (7.9) |
|
|
Type of water drinking indoor |
|
|
|
0.001 |
|
Water purifier, bottled water, etc. |
2,047 (71.4) |
896 (73.5) |
1,151 (69.4) |
|
|
Underground water, small-scale water-supply system, tap water |
946 (28.6) |
402 (26.5) |
544 (30.6) |
|
|
Type of water drinking outdoor |
|
|
|
<0.001 |
|
Water purifier, bottled water, etc. |
2,747 (93.3) |
1,207 (95.1) |
1,540 (91.4) |
|
|
Underground water, small-scale water-supply system, tap water |
246 (6.7) |
91 (4.9) |
155 (8.6) |
|
|
Average ventilation time per day (minutes) |
|
|
|
0.043 |
|
<30 |
354 (10.5) |
174 (11.3) |
180 (9.7) |
|
|
≥30, <60 |
371 (11.1) |
156 (10.6) |
215 (11.4) |
|
|
≥60, <600 |
1,112 (36.6) |
488 (37.7) |
624 (35.6) |
|
|
≥600 |
1,156 (41.8) |
480 (40.4) |
676 (43.3) |
|
Table 2.Distribution of serum PFAS in men according to variables: PFOA and PFOS
|
Variable |
PFOA |
PFOS |
|
Low (n = 974)a
|
High (n = 324) |
p-value |
Low (n = 974) |
High (n = 324) |
p-value |
|
Age (years) |
43.5 ± 0.29 |
57.3 ± 0.22 |
<0.001b
|
43.1 ± 0.21 |
60.3 ± 0.99 |
<0.001 |
|
BMI (kg/m2) |
|
|
0.081c
|
|
|
0.763 |
|
≤25 |
460 (79.3) |
135 (20.7) |
|
454 (81.1) |
141 (18.9) |
|
|
>25 |
514 (78.3) |
189 (21.7) |
|
520 (81.1) |
183 (18.9) |
|
|
Outdoor clothing use |
|
|
0.004 |
|
|
0.011 |
|
None |
442 (83.1) |
115 (16.9) |
|
430 (84.6) |
127 (15.4) |
|
|
<Four times a week |
319 (76.0) |
127 (24.0) |
|
328 (77.3) |
118 (22.7) |
|
|
≥Four times a week |
213 (74.4) |
82 (25.6) |
|
216 (80.1) |
79 (19.9) |
|
|
Coated frying pans use |
|
|
0.086 |
|
|
0.004 |
|
None |
27 (82.6) |
12 (17.4) |
|
30 (88.2) |
9 (11.8) |
|
|
<Four times a week |
429 (78.2) |
128 (21.8) |
|
406 (78.6) |
151 (21.4) |
|
|
≥Four times a week |
518 (79.0) |
184 (21.0) |
|
538 (82.3) |
164 (17.7) |
|
|
Crustacean consumption |
|
|
0.001 |
|
|
0.001 |
|
<Once a week |
902 (80.2) |
287 (19.8) |
|
895 (82.1) |
294 (17.9) |
|
|
≥Once a week |
72 (63.2) |
37 (36.8) |
|
79 (69.7) |
30 (30.3) |
|
|
Type of water drinking indoor |
|
|
0.009 |
|
|
0.006 |
|
Water purifier, bottled water, etc. |
688 (82.2) |
202 (17.8) |
|
687 (84.8) |
203 (15.2) |
|
|
Underground water, small-scale water-supply system, tap water |
286 (69.3) |
122 (30.7) |
|
287 (71.1) |
121 (28.9) |
|
|
Type of water drinking outdoor |
|
|
0.013 |
|
|
0.001 |
|
Water purifier, bottled water, etc. |
901 (79.4) |
290 (20.6) |
|
908 (82.1) |
283 (17.9) |
|
|
Underground water, small-scale water-supply system, tap water |
73 (68.0) |
34 (32.0) |
|
66 (63.7) |
41 (36.3) |
|
|
Average ventilation time per day (minutes) |
|
|
0.005 |
|
|
0.003 |
|
<30 |
122 (74.7) |
52 (25.3) |
|
123 (76.0) |
51 (24.0) |
|
|
≥30, <60 |
116 (81.9) |
40 (18.1) |
|
116 (84.9) |
40 (15.1) |
|
|
≥60, <600 |
373 (76.7) |
115 (23.3) |
|
359 (76.9) |
129 (23.1) |
|
|
≥600 |
363 (81.0) |
117 (19.0) |
|
376 (85.4) |
104 (14.6) |
|
Table 3.Distribution of serum PFAS in men according to variables: PFHxS, PFNA, and PFDeA
|
Variable |
PFHxS |
PFNA |
PFDeA |
|
Low (n = 974)a
|
High (n = 324) |
p-value |
Low (n = 974) |
High (n = 324) |
p-value |
Low (n = 974) |
High (n = 324) |
p-value |
|
Age (years) |
44.1 ± 0.35 |
53.8 ± 0.06 |
0.002b
|
43.0 ± 0.28 |
60.2 ± 0.04 |
<0.001 |
43.1 ± 0.28 |
60.3 ± 0.20 |
<0.001 |
|
BMI (kg/m2) |
|
|
0.017c
|
|
|
0.082 |
|
|
0.062 |
|
≤25 |
454 (75.1) |
141 (24.9) |
|
456 (81.3) |
139 (18.7) |
|
458 (81.4) |
137 (18.6) |
|
|
>25 |
520 (76.9) |
183 (23.1) |
|
518 (79.7) |
185 (20.3) |
|
516 (80.4) |
187 (19.6) |
|
|
Outdoor clothing use |
|
|
0.006 |
|
|
0.011 |
|
|
<0.001 |
|
None |
429 (81.1) |
128 (18.9) |
|
433 (84.0) |
124 (16.0) |
|
442 (85.3) |
115 (14.7) |
|
|
<Four times a week |
326 (72.5) |
120 (27.5) |
|
335 (78.4) |
111 (21.6) |
|
326 (77.6) |
120 (22.4) |
|
|
≥Four times a week |
219 (71.6) |
76 (28.4) |
|
206 (76.4) |
89 (23.6) |
|
206 (77.1) |
89 (22.9) |
|
|
Coated frying pans use |
|
|
0.155 |
|
|
0.005 |
|
|
<0.001 |
|
None |
29 (88.5) |
10 (11.5) |
|
26 (82.4) |
13 (17.6) |
|
31 (89.4) |
8 (10.6) |
|
|
<Four times a week |
422 (75.7) |
135 (24.3) |
|
405 (77.7) |
152 (22.3) |
|
403 (77.0) |
154 (23.0) |
|
|
≥Four times a week |
523 (75.7) |
179 (24.3) |
|
543 (82.0) |
159 (18.0) |
|
540 (82.9) |
162 (17.1) |
|
|
Crustacean consumption |
|
|
0.011 |
|
|
0.001 |
|
|
<0.001 |
|
<Once a week |
900 (77.7) |
289 (22.3) |
|
894 (82.0) |
295 (18.0) |
|
897 (82.6) |
292 (17.4) |
|
|
≥Once a week |
74 (58.5) |
35 (41.5) |
|
80 (63.4) |
29 (36.6) |
|
77 (62.1) |
32 (37.9) |
|
|
Type of water drinking indoor |
|
|
0.009 |
|
|
0.003 |
|
|
0.004 |
|
Water purifier, bottled water, etc. |
677 (78.1) |
213 (21.9) |
|
695 (84.4) |
195 (15.6) |
|
697 (85.0) |
193 (15.0) |
|
|
Underground water, small-scale water-supply system, tap water |
297 (70.6) |
111 (29.4) |
|
279 (69.5) |
129 (30.5) |
|
277 (69.7) |
131 (30.3) |
|
|
Type of water drinking outdoor |
|
|
0.001 |
|
|
0.002 |
|
|
0.003 |
|
Water purifier, bottled water, etc. |
894 (76.6) |
297 (23.4) |
|
908 (81.4) |
283 (18.6) |
|
908 (81.9) |
283 (18.1) |
|
|
Underground water, small-scale water-supply system, tap water |
80 (66.1) |
27 (33.9) |
|
66 (62.9) |
41 (37.1) |
|
66 (62.9) |
41 (37.1) |
|
|
Average ventilation time per day (minutes) |
|
|
0.006 |
|
|
0.008 |
|
|
0.052 |
|
<30 |
125 (71.1) |
49 (28.9) |
|
119 (73.8) |
55 (26.2) |
|
125 (77.2) |
49 (22.8) |
|
|
≥30, <60 |
117 (83.8) |
39 (16.2) |
|
119 (85.0) |
37 (15.0) |
|
116 (83.2) |
40 (16.8) |
|
|
≥60, <600 |
362 (71.6) |
126 (28.4) |
|
369 (78.6) |
119 (21.4) |
|
361 (78.3) |
127 (21.7) |
|
|
≥600 |
370 (79.6) |
110 (20.4) |
|
367 (82.8) |
113 (17.2) |
|
372 (83.6) |
108 (16.4) |
|
Table 4.Distribution of serum PFAS in women according to variables: PFOA and PFOS
|
Variable |
PFOA |
PFOS |
|
Low (n = 1,272)a
|
High (n = 423) |
p-value |
Low (n = 1,272) |
High (n = 423) |
p-value |
|
Age (years) |
44.9 ± 0.15 |
61.5 ± 0.07 |
<0.001b
|
44.8 ± 0.03 |
62.7 ± 0.06 |
<0.001 |
|
BMI (kg/m2) |
|
|
<0.001c
|
|
|
0.004 |
|
≤25 |
775 (83.0) |
207 (17.0) |
|
779 (82.8) |
203 (17.2) |
|
|
>25 |
497 (70.5) |
216 (29.5) |
|
493 (73.9) |
220 (26.1) |
|
|
Outdoor clothing use |
|
|
0.002 |
|
|
<0.001 |
|
None |
769 (81.1) |
215 (18.9) |
|
759 (81.5) |
225 (18.5) |
|
|
<Four times a week |
400 (75.0) |
156 (25.0) |
|
412 (79.0) |
144 (21.0) |
|
|
≥Four times a week |
103 (67.5) |
52 (32.5) |
|
101 (64.5) |
54 (35.5) |
|
|
Coated frying pans use |
|
|
0.007 |
|
|
0.040 |
|
None |
31 (78.2) |
13 (21.8) |
|
28 (77.6) |
16 (22.4) |
|
|
<Four times a week |
540 (72.2) |
216 (27.8) |
|
535 (75.8) |
221 (24.2) |
|
|
≥Four times a week |
701 (82.8) |
194 (17.2) |
|
709 (82.1) |
186 (17.9) |
|
|
Crustacean consumption |
|
|
0.792 |
|
|
0.213 |
|
<Once a week |
1,182 (78.1) |
382 (21.9) |
|
1,178 (79.5) |
386 (20.5) |
|
|
≥Once a week |
90 (78.2) |
41 (21.8) |
|
94 (77.5) |
37 (22.5) |
|
|
Type of water drinking indoor |
|
|
0.004 |
|
|
0.006 |
|
Water purifier, bottled water, etc. |
893 (80.5) |
253 (19.5) |
|
905 (82.9) |
241 (17.1) |
|
|
Underground water, small-scale water-supply system, tap water |
379 (72.8) |
170 (27.2) |
|
367 (71.2) |
182 (28.8) |
|
|
Type of water drinking outdoor |
|
|
0.002 |
|
|
0.002 |
|
Water purifier, bottled water, etc. |
1,159 (79.9) |
352 (20.1) |
|
1,159 (81.7) |
352 (18.3) |
|
|
Underground water, small-scale water-supply system, tap water |
113 (62.0) |
71 (38.0) |
|
113 (58.3) |
71 (41.7) |
|
|
Average ventilation time per day (minutes) |
|
|
0.015 |
|
|
0.062 |
|
<30 |
128 (67.1) |
52 (32.9) |
|
135 (79.0) |
45 (21.0) |
|
|
≥30, <60 |
153 (75.6) |
62 (24.4) |
|
154 (76.0) |
61 (24.0) |
|
|
≥60, <600 |
467 (76.6) |
157 (23.4) |
|
465 (77.8) |
159 (22.2) |
|
|
≥600 |
524 (82.4) |
152 (17.6) |
|
518 (81.5) |
158 (18.5) |
|
Table 5.Distribution of serum PFAS in women according to variables: PFHxS, PFNA, and PFDeA
|
Variable |
PFHxS |
PFNA |
PFDeA |
|
Low (n = 1,272)a
|
High (n = 423) |
p-value |
Low (n = 1,272) |
High (n = 423) |
p-value |
Low (n = 1,272) |
High (n = 423) |
p-value |
|
Age (years) |
45.6 ± 0.25 |
58.4 ± 0.27 |
<0.001b
|
44.8 ± 0.06 |
63.3 ± 0.09 |
<0.001 |
45.3 ± 0.15 |
61.1 ± 0.07 |
<0.001 |
|
BMI (kg/m2) |
|
|
0.024c
|
|
|
<0.001 |
|
|
0.004 |
|
≤25 |
749 (79.3) |
233 (20.7) |
|
782 (84.9) |
200 (15.1) |
|
770 (82.3) |
212 (17.7) |
|
|
>25 |
523 (73.8) |
190 (26.2) |
|
490 (72.3) |
223 (27.7) |
|
502 (74.8) |
211 (25.2) |
|
|
Outdoor clothing use |
|
|
0.002 |
|
|
0.002 |
|
|
0.014 |
|
None |
771 (80.6) |
213 (19.4) |
|
759 (81.3) |
225 (18.7) |
|
765 (82.0) |
219 (18.0) |
|
|
<Four times a week |
399 (74.9) |
157 (25.1) |
|
407 (78.9) |
149 (21.1) |
|
401 (76.2) |
155 (23.8) |
|
|
≥Four times a week |
102 (60.6) |
53 (39.4) |
|
106 (74.0) |
49 (26.0) |
|
106 (72.2) |
49 (27.8) |
|
|
Coated frying pans use |
|
|
0.080 |
|
|
0.009 |
|
|
0.008 |
|
None |
32 (82.4) |
12 (17.6) |
|
30 (78.8) |
14 (21.2) |
|
30 (78.4) |
14 (21.6) |
|
|
<Four times a week |
552 (76.2) |
204 (23.8) |
|
532 (75.1) |
224 (24.9) |
|
535 (75.3) |
221 (24.7) |
|
|
≥Four times a week |
688 (77.7) |
207 (22.3) |
|
710 (83.9) |
185 (16.1) |
|
707 (82.7) |
188 (17.3) |
|
|
Crustacean consumption |
|
|
0.517 |
|
|
0.090 |
|
|
0.024 |
|
<Once a week |
1,179 (77.3) |
385 (22.7) |
|
1,177 (79.7) |
387 (20.3) |
|
1,179 (79.6) |
385 (20.4) |
|
|
≥Once a week |
93 (75.5) |
38 (24.5) |
|
95 (82.5) |
36 (17.5) |
|
93 (76.6) |
38 (23.4) |
|
|
Type of water drinking indoor |
|
|
0.003 |
|
|
0.006 |
|
|
0.016 |
|
Water purifier, bottled water, etc. |
885 (80.5) |
261 (19.5) |
|
904 (83.5) |
242 (16.5) |
|
909 (82.9) |
237 (17.1) |
|
|
Underground water, small-scale water-supply system, tap water |
387 (69.6) |
162 (30.4) |
|
368 (72.0) |
181 (28.0) |
|
363 (71.5) |
186 (28.5) |
|
|
Type of water drinking outdoor |
|
|
<0.001 |
|
|
<0.001 |
|
|
<0.001 |
|
Water purifier, bottled water, etc. |
1,147 (79.2) |
364 (20.8) |
|
1,167 (83.2) |
344 (16.8) |
|
1,157 (81.7) |
354 (18.3) |
|
|
Underground water, small-scale water-supply system, tap water |
125 (59.7) |
59 (40.3) |
|
105 (51.8) |
79 (48.2) |
|
115 (59.2) |
69 (40.8) |
|
|
Average ventilation time per day (minutes) |
|
|
0.127 |
|
|
0.214 |
|
|
0.213 |
|
<30 |
134 (77.0) |
46 (23.0) |
|
135 (76.4) |
45 (23.6) |
|
135 (73.6) |
45 (26.4) |
|
|
≥30, <60 |
158 (76.2) |
57 (23.8) |
|
155 (78.4) |
60 (21.6) |
|
161 (79.2) |
54 (20.8) |
|
|
≥60, <600 |
463 (73.2) |
161 (26.8) |
|
462 (78.9) |
162 (21.1) |
|
455 (79.0) |
169 (21.0) |
|
|
≥600 |
517 (80.7) |
159 (19.3) |
|
520 (82.1) |
156 (17.9) |
|
521 (81.0) |
155 (19.0) |
|
Table 6.Adjusted ORs and 95% CIs of use of outdoor clothing with high concentrations of serum PFAS
|
Category |
Unadjusted |
Adjusteda
|
|
None |
<4 times a week |
≥4 times a week |
None |
<4 times a week |
≥4 times a week |
|
Men |
|
|
|
|
|
|
|
PFOA |
1 |
1.55 (1.38–1.75) |
1.70 (1.65–1.75) |
1 |
1.26 (1.10–1.44) |
1.70 (1.40–2.07) |
|
PFOS |
1 |
1.61 (1.26–2.05) |
1.36 (1.23–1.51) |
1 |
1.66 (1.47–1.89) |
1.57 (1.05–2.34) |
|
PFHxS |
1 |
1.63 (1.32–2.01) |
1.70 (1.60–1.82) |
1 |
1.49 (1.16–1.92) |
1.70 (1.22–2.37) |
|
PFNA |
1 |
1.45 (1.30–1.62) |
1.62 (1.38–1.90) |
1 |
1.34 (1.19–1.51) |
1.68 (1.38–2.05) |
|
PFDeA |
1 |
1.68 (1.49–1.90) |
1.72 (1.52–1.95) |
1 |
1.62 (1.16–2.27) |
1.79 (1.59–2.02) |
|
Women |
|
|
|
|
|
|
|
PFOA |
1 |
1.43 (1.36–1.51) |
2.07 (1.77–2.41) |
1 |
1.32 (1.19–1.46) |
1.53 (1.01–2.32) |
|
PFOS |
1 |
1.17 (1.06–1.30) |
2.43 (2.25–2.63) |
1 |
1.16 (1.08–1.25) |
1.84 (1.45–2.34) |
|
PFHxS |
1 |
1.40 (1.21–1.62) |
2.70 (2.51–2.90) |
1 |
1.46 (1.08–1.96) |
2.63 (2.10–3.29) |
|
PFNA |
1 |
1.17 (1.07–1.28) |
1.53 (1.42–1.65) |
1 |
1.38 (1.22–1.55) |
1.45 (1.07–1.96) |
|
PFDeA |
1 |
1.42 (1.38–1.46) |
1.75 (1.21–2.54) |
1 |
1.47 (1.23–1.77) |
1.44 (1.35–1.52) |
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