title: Association of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) with uric acid among adults with elevated community exposure to PFOA.
abstract: BACKGROUND
  Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are compounds that do not occur in nature, have been widely used since World War II, and persist indefinitely in most environments. Median serum levels in the United States are 4 ng/mL for PFOA and 21 ng/mL for PFOS. PFOA has been associated with elevated uric acid in two studies of chemical workers. Uric acid is a risk factor for hypertension and possibly other cardiovascular outcomes.
  
  
  METHODS
  We conducted a cross-sectional study of PFOA and PFOS and uric acid among 54,951 adult community residents in Ohio and West Virginia, who lived or worked in six water districts contaminated with PFOA from a chemical plant. Analyses were conducted by linear and logistic regression, adjusted for confounders.
  
  
  RESULTS
  Both PFOA and PFOS were significantly associated with uric acid. An increase of 0.20.3 mg/dL uric acid was associated with an increase from the lowest to highest decile of either PFOA or PFOS. Hyperuricemia risk increased modestly with increasing PFOA; the odds ratios by quintile of PFOA were 1.00, 1.33 [95% confidence interval (CI), 1.241.43], 1.35 (95% CI, 1.261.45), 1.47 (95% CI, 1.371.58), and 1.47 (95% CI, 1.371.58; test for trend, p < 0.0001). We saw a less steep trend for PFOS. Inclusion of both correlated fluorocarbons in the model indicated PFOA was a more important predictor than was PFOS.
  
  
  CONCLUSIONS
  Higher serum levels of PFOA were associated with a higher prevalence of hyperuricemia, but the limitations of cross-sectional data and the possibility of noncausal mechanisms prohibit conclusions regarding causality.
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. nsteenl@sph.emory.edu
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
authors.forename: Sarah
authors.initials: S
authors.lastname: Tinker
authors.forename: Anoop
authors.initials: A
authors.lastname: Shankar
authors.forename: Alan
authors.initials: A
authors.lastname: Ducatman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017738:Alkanesulfonic Acids / Q000097:blood*; D002210:Caprylates / Q000009:adverse effects* / Q000097:blood*; D004785:Environmental Pollutants / Q000009:adverse effects / Q000097:blood; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects* / Q000097:blood*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009820:Ohio; D014527:Uric Acid / Q000097:blood*; D014903:West Virginia; D055815:Young Adult
chemical_list: D017738:Alkanesulfonic Acids; D002210:Caprylates; D004785:Environmental Pollutants; D005466:Fluorocarbons; D014527:Uric Acid; C023036:perfluorooctanoic acid; C076994:perfluorooctane sulfonic acid