Incidence of respiratory diseases associated with per- and polyfluoroalkyl substances (PFAS) in PM2.5: New evidence from a population-based survey of Pearl River Delta (PRD), China

Epidemiological studies have evinced that particulate matter (PM) is linked to respiratory diseases, but the relationship between the specific constituents of PM and respiratory diseases remains scarce. Here, we evaluated the relationship between PFAS in PM_2.5 with respiratory diseases. In this study, from May 2016 to May 2018, we recruited 131,346 school-aged children and adolescents living in Pearl River Delta, Guangdong Province, China. Participants self-reported the respiratory diseases, including asthma, wheezing, phlegm, cough and rhinitis. Logistic regression and qg-comp models were used to analyze the relationship between PFAS exposure and respiratory diseases. We found several PFAS were significantly associated with higher prevalence of respiratory diseases. For instance, higher quintiles of PFSA exposure (Q2-Q4), as compared to Q1, were associated with greater odds of respiratory diseases: 1.35 (95 %CI: 1.23, 1.48) in Q2, 1.95 (95 %CI: 1.78, 2.14) in Q3 and 2.83 (95 %CI: 2.76, 3.11) in Q4. Furthermore, qg-comp model analysis revealed PFCA as the most important weight in respiratory diseases. Moreover, the effect estimates were higher in boys, older children (>12 years old) and overweight/obesity, indicating the vulnerability of these subpopulations. In summary, exposure to PFAS, a specific PM_2.5 constituent, potentially increases the risk of respiratory diseases among school-aged children and adolescents.