All-cause, circulatory disease and cancer mortality in the population of a large Italian area contaminated by perfluoroalkyl and polyfluoroalkyl substances (1980-2018)

BackgroundPerfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. A clear association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (north-eastern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. MethodsThe Italian National Institute of Health and the Italian National Institute of Statistics made available the anonymous records of death certificates of residents of the provinces of Vicenza, Verona and Padova (males, n=29,629; females, n=29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardized (European standard population 2013) mortality ratios using the total population of the three provinces in the same calendar period as a reference. The birth cohort analysis was performed using cumulative risks for ages 20-84 years. ResultsDuring the 33 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of available cause-specific mortality), in the resident population of the Red area (the municipalities being connect to the contaminated water plant) we observed 51,621 deaths as compared to 47,731 expected (age-sex SMR: 108; 90% CI: 107-109). We found evidence of raised mortality for diseases of the circulatory system (in particular, heart disease and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. ConclusionsFor the first time, an association of PFAS exposure with mortality from circulatory disease mortality was formally demonstrated. Circumstantial evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.