Document 066zgDGwxOOOygdZDmwJXJO5x

AR226 -- 107] company Cele Page Lof 121 FINAL REPORT Epidemiology, 220-3W-05 Medical Department 3M Company St. Paul, MN 55144 Date: October 11,2001" Title: A Cross-sectional Analysis of Serum Perfluorooctanesulfonate (PFOS) and Perfluorooctanoate (PFOA) in Relation to Clinical Chemistry, Thyroid Hormone, Hematology and Urinalysis Results from Male and Female Employee Participants of the 2000 Antwerp and Decatur Fluorochemical Medical Surveillance Program Study Start Date: March 1, 2000 Protocol Number (not applicable) IRB Approval Exempt Expedited x IRB Approval Date: (not applicable as these data are from a medical surveillance program) Principal Investigator: Co-investigators: Study Director: Geary W. Olsen, D.V.M., Ph.D." Michele M. Burlew, M.S." Jean M. Burris, RN., MPH." Jeffrey H. Mandel, MD., MP.H.! Jeffrey H. Mandel, MD., MPH." 1. 3M Medical Department. 220-3W-05, St. Paul, MN. 55144-1000 "(Corrections made from previous version) = j5adi 9IR oz r2n OO8F5 000133 EE 3PaMgCeo2mofpa1n2y1 ABSTRACT `The 3M fluorochemical medical surveillance program is conducted on a routine periodic basis at the company's Antwerp (Belgium) and Decatur (Alabama) fluorochemical manufacturing plants. In the most recent occurrence in 2000, there were 255 Antwerp employees (206 male and 49 female) and 263 Decatur employees (215 `male, 48 female) who participated in the program. This represents approximately 75 percent and 50 percentofthe eligible employees at these two locations, respectively. Seventy three percent of the participating Antwerp male employees and 75 percent ofthe Decatur employees were engaged in production activities. Only 12 percent of the participating Antwerp female employees were engaged in production activities compared 1063 percent of the Decatur female employees. Employees' sera were quantitatively analyzed for PFOS (perfluorooctanesulfonate), PFOA (perfluorooctanoate), PFHS (perfluorohexanesulfonate), POSAA (N-ethyl perfluorooctanesulfonamidoacetate), M570 (N-methyl perfluorooctanesulfonamidoacetate), PFOSA (perfluorooctanesulfonateamide) and M556 (perfluorooctanesulfonamidoacetate) using high-pressure liquid chromatography/electrospray tandem mass spectrometry (HPLC/ESMSMS) and evaluated versus an extracted curve from a human serum matrix. A total organic fluorine index (TOF) was also determined by calculating the percent of each specific fluorochemical's molecular weight that was attributed to organic fluorine: and multiplied by the ppm measured for each fluorochemical and then summed across all seven fluorochemicals. 00134 P3aMgeC3oomfpa1n2y1 Mean serum POS levels for Antwerp production and non-production male workers were 1.16 and 0.42 ppm, respectively. Among Decatur production and nonproduction male workers, their mean serum PFOS levels were 1.63 and 0.73 ppm, respectively. Mean serum PFOA levels for Antwerp male production and non-production `workers were 1.28 and 0.34 ppm, respectively. Among Decatur male production and non-production workers, their mean serum PFOA levels were 2.34 and 0.59 ppm, respectively. The mean PFOS and PFOA levels for the Antwerp female employees (primarily nonproduction) were 0.13 ppmand 0.07 ppm, respectively. The mean PFOS and PFOA levels for Decatur female production and nonproduction employees were 0.93 and 1.23 ppm, respectively. Separate reports have been written which analyzed the employees' serum levels in relation to theirjob and building location work assignments as obtained from a self-reported work history questionnaire. A standard set of hematological and clinical chemistry tests were analyzed. These included the following hematological tests: hematocrit (percent), hemoglobin (gm/dl), red blood cells (RBC, 1000/mm?), white blood cells (WBC, 1000/ mm') and platelet count (1000/ mm); and the following clinical chemistry tests: alkaline phosphatase (IU/L), `gamma glutamyl transferase (GGT, IU/L), aspartate aminotransferase (AST, IU/L), alanine aminotransferase (ALT, IU/L), total and direct bilirubin (mg/dl), blood urea nitrogen (BUN, mg/dl), serum creatinine (mg/dl), blood glucose (mg/dl), cholesterol (mg/d). high density cholesterol (HDL, mg/dl) and triglycerides (mg/dl). Urinalyses were only assessed for Decatur employees via the standard urine microstick analysis, which tested for urine glucose. albumin and red blood cells. Six thyroid hormones were also assayed: thyroid stimulating hormone (TSH: pIU/mI): serum thyroxine (T4; g/dL); 000135 P3aMgeCdoomfpa1n2y1 free thyroxine (free T4; ng/dL); serum triiodothyronine (T3; pg/mL); thyroid hormone binding ratio (THBR, %, previously referred to as T3 Uptake) and free thyroxine index (ETD. Statistical analyses were conducted on the entire surveillance population as well as subgroups by gender, production worker (yes/no) and location. Univariate analyses categorized mean levels by serum PFOS quartile distributions. Multivariable regression wasusedto analyze the clinical chemistry and thyroid hormones as dependent variables in relation to the independent effects of PFOS, PFOA or TOF adjusted for several demographic variables (age, body mass index, number of alcoholic drinks per day, cigarettes smoked per day and years worked). There vids a modest positive association between PFOS or PFOA with cholesterol as well as a stronger positive association between PFOA and triglycerides. These i" associations are inconsistent with the known toxicological evidence that has shown the hypolipidemic (not hyperlipidemic) effect of PFOS (in rats and primates) and PFOA (in rats but no effect in primates) at dosages that produced serum PFOS or PFOA levels higher than those measured in this population. Therefore, itis unlikely the observed positive associations between PFOS or PFOA and lipids are causal. Because of the potential confounding positive association with serum triglycerides, ths variable was added to the hepatic clinical chemistry models as an independent variable. In these models, no significant associations were observed with PFOS, PFOA or TOF in relation to alkaline phosphatase, GGT, AST, ALT or total bilirubin. Although T3 was positively associated with PFOA. no other thyroid hormones were associated with PFOS, PFOA or TOF: thus there is unlikely a causal explanation (.g., hypothyroidism or 000136 P3aMgeCoSmopfa2n1y hyperthyroidism) for thispositiveT3 association with PFOA. Hematological and urinalysis results were unremarkable. In summary, the findings from the 2000 fluorochemical medical surveillance program continue to suggest that Antwerp and Decatur fluorochemical production and `non-production employees do not have significant changes in serum cholesterol, lipoproteins or hepatic enzymes that are consistent with toxicological findings in laboratory animals. Limitations of the study include its cross-sectional design, the: Voluntary participation rates and the lower levels of serum PFOS and PFOA measured among these employees compared with those suspectedto cause effects in laboratory animals. A longitudinal analysis is reported separately for the fluorochemical medical surveillance Antwerp and Decatur program data from 1994 through 2000. 000137 P3aMgeCobmopfa1n2y1 INTRODUCTION "The 3M fluorochemical medical surveillance program is conducted on aroutine. `periodic basis at the company's Antwerp (Belgium) and Decatur (Alabama) fluorochemical manufacturing plants. Prior to 1994, total organic fluorine was measured rather thananyspecific fluorochemical analyte. Serum perfluorooctanesulfonate (PFOS) and perfluorooctanoate (PFOA) have been routinely assayed since 1994/95 rather than total organic fluorine. An analysis of the 1994/95 and 1997 medical surveillance `program data in relation to Antwerp and Decatur employees' serum PFOS levels have: been reported elsewhere (Olsen et al, 19983, 1999a). In the 1994/1995 medical surveillance program, a total of 178 employees participated (Antwerp = 88; Decatur = 90) and 149 employees participated in 1997 (Antwerp = 65; Decatur = 84). A total of 61 Antwerp and Decatur employees participated in both years. The Antwerp male employee `population was significantly younger than that at Decatur, had lower Body Mass Indices (BMI) and had higher self-reported daily consumption of alcohol. In addition, the employees' clinical chemistry profiles were different for several tests. The Antwerp employee population had lower mean alkaline phosphatase and triglyceride values and higher total bilirubin and HDL values than the Decatur employee population. The findings from this prior epidemiologic analysis suggested that significant clinical chemistry and hematological abnormalities were not associated with serum perfluorooctanesulfonate (PFOS) levels up to 6 parts per million (Olsen et al 1998a; 19993). Nor were there consistent associations reported between serum PFOS and several hormone tests including testosterone, estradiol and thyroid stimulating hormone (TSH). It was not possible to derive inferences from the few employees who had serum 000138 3PaMgeC7oompfa1n2y1 PFOS levels > 6 ppm. An important limitation of this prior analysis was the low Voluntary participation of male employees (less than 50%) and insufficient sample size of female employees which prevented a separate analysis. Also, although serum perfluorooctanoate (PFOA) was measured, it was not included in the analyses. Because the voluntary nature of the medical surveillance program may not `provide for a complete understanding of the distribution of serum fluorochemical levels in the Decatur workforce, a random sample of 232 employees was selected for fluorochemical testing in the Fall, 1998. The distributions of employee serum PFOS and PFOA levels were comparable to the results reported in the voluntary Decatur medical surveillance program (Olsen etal 1999b). This finding suggested that the distribution of Serum fluorochemical levels observed in the prior voluntary medical surveillance program likely reflected the distributionof serum PFOS and PFOA levels of all . employees in the chemical plant. Detailed discussions of the toxicology and epidemiology of PFOS and PFOA have been reported elsewhere (3M Company 2000; Alexander 2001; 2001b; Butenhoff etal 2001: Gilliland and Mandel 1993:1996; Haughom and Spydevold 1992; Olsen et al 19982: 1998b; 1999; 2000; Pastor et al 1987; Seacat et al 2001a; 2001b; Sohleniusetal 1993). For the purpose of brevity, this information will not be summarized in this Introduction. Suffice it to mention that for the purposeof employee medical surveillance, PFOS has been reported to be an inducer of peroxisome proliferation and hypolipidemia in rodents (Pastoor et al 1987: Ikeda et al 1987: Haughom and Spydevold 1992; Seacat et a1 2001a: Sohlenius et al 1993) and primates (Seacat et al 2001b). PFOA has been inconsistently reported to produce hypolipidemia in rodents (Pastooert al 1987; 000139 P3aMgeC8oomfpa1n2y1 Haughom and Spydevold 1992;) and not in primates (Butenhoff et al 2001). The mechanism of action pertaining to this hypolipidemia remains to be fully elucidated. The purpose of this report was to conduct a cross-sectional analysis of the 2000 fluorochemical medical surveillance program for Antwerp and Decatur male and female employees. Unlike the earlier report for Antwerp and Decatur employees which only analyzed for PFOS (Olsen et al 19983; 1999), the present study examined associations for both PFOS and/or PFOA as well as a calculated measure for total organic fluorine (TOP). Longitudinal analysesof employees who participated from 1994/95 through 2000 `were not analyzed as this was a focus ofa separate analytical report (Olsen et al 2001). METHODS `The fluorochemical medical surveillance program is available, on 2 voluntary basis, to all Antwerp and Decatur chemical plant employees and those site employees who may work in the chemical plant area. In 2000, approximately 340 Antwerp and 500 Decatur chemical plant and site employees were eligible to participate. In addition to the fluorochemical testing program, a standard battery of clinical chemistry, pulmonary function and urinalysis (Decatur only) tests were performed on employees. In addition, Several thyroid hormones were measured. A site-specific work history was also administered to all employee participants. Analyses of these self-reported workplace: questionnaire data in conjunction with the employees' serum fluorochemical levels have: been reported elsewhere for Antwerp (Olsen et al 2001b) and Decatur (Olsen et al, 20010). 000140 R P3aMgeCodmofpa1n2y1 `Hematology, Clinical Chemistry and Urinalysis Alina Laboratory Services (St. Paul, Minnesota) performed the standard hematological and clinical chemistry tests. These included the following hematological tests: hematocrit (percent), hemoglobin (gm/di), red blood cells (RBC, 1000/mm'), white blood cells (WBC, 1000/ mm') and platelet count (1000/ mm); and the following clinical chemistry tests: alkaline phosphatase (IU/L), gamma glutamyl transferase (GGT, * IU/L), aspartate aminotransferase (AST, IU/L), alanine aminotransferase (ALT, TUL), total and direct bilirubin (mg/dl),bloodurea nitrogen (BUN, mg/dl), serum creatinine (mg/d), blood glucose (mg/dl), cholesterol (mg/dl), high density cholesterol (HDL, mg/dl) and triglycerides (mg/dl). Urinalyses were only assessed for Decatur employees via the standard urine microstick analysis which tested for urine glucose, albumin and red blood cells. _ ThyroidHormones Six thyroid tests were conducted by LabCorp (Kansas City, MO): thyroid stimulating hormone (TSH; pIU/ml); serum thyroxine (T4; ug/dL); free thyroxine (free `T4: ng/dL): serum triiodothyronine (T3; pg/mL); thyroid hormone binding ratio (THBR, %, previously referred to as T3 Uptake) and free thyroxine index (FTI). TSH, free T4 and T3 were determinedbyan immunochemiluminometric assay (ICMA). T4 and THBR were determined by acloned enzyme donor immunoassay (CEDIA). FTI was calculated by multiplying T4 and THBR. 000141 Pa3gMe C1o0m0pfa1n2y1 Fluorochemical Analyses . Sera samples were extracted using an ion-pairing extraction procedure (Hansen et al, 2001). The extracts were quantitatively analyzed for PFOS (perfluorooctanesulfonate), PFOA (perfluorooctanoate), PFHS (perfluorohexanesulfonate), PFOSAA (N-ethyl perfluorooctanesulfonamidoacetate), M570 (N-methyl perfluorooctanesulfonamidoacetate), PFOSA (perfluorooctanesulfonateamide) and M556 (perfluorooctariesulfonamidoacetate) using high-pressure liquid chromatography/electrospray tandem mass spectrometry (HPLC/ESMSMS) and evaluated versus an extracted curve from a human serum matrix. Endogenous levels of certain fluorochemical were determined in the standard serum matrix and additional fluorochemical was spiked into the matrix. The total amount of each specific fluorochemical (endogenous + spiked) was used to construct an extracted standard curve. All serum fluorochemical analyses were determined by Northwest Bioanaltyical Laboratory In. (Salt Lake City, UT). A description of the distribution of the serum fluorochemical levels is reported elsewhere for Antwerp (Olsen et al, 2001b) and Decatur (Olsen et al, 2001c). For Antwerp, all employee serum values for PFOS and PFOA values were above the lower limitof quantitation (LLOQ). There was one employee (0.3 percent) with a PFHS value below the LLOQ (0.0027 ppm) and one employee (0.3 percent) with a M570 below the LLOQ (0.0057 ppm). There were L11 employees (44 percent) with PFOSAA values below the LLOQ (0.006 ppm); 88 employees (35 percent) were below the LLOQ (0.001 ppm) for PFOSA; and 13 employees (5 percent) were below the LLOQ (0.0043 000142 3M Company Page IL of 121 ppm) for M556. For Decatur, all employee serum values for PFOS, PFHS, PFOA and M570 were above the respective lower limit of quantitation (LLOQ). There were 8 (3 percent) employees with PEOSAA values below the LLOQ (0.006 ppm); 111 employees (42 percent) were below the LLOQ for PFOSA (0.001 ppm); and 13 employees (5 percent) were below the LLOQ for M556 (0.0043 ppm). For statistical analysis purposes, serum fluorochemical values that were less than the LLOQ were assumed to be the `midpoint between zero and the LLOQ. A total organic fluorine index (TOF) was determined by calculating the percent of each specific fluorochemical's molecular weight that was attributed to organic fluorine (POS (64.79%); PEHS (61.9%): PFOA (69.0%); PFOSAA (55.3%); PFOSA (64.7%); MS70 (56.6%) and M556 (58.1%) multiplied by the ppm measured for each fluorochemical and then summed across all seven fluorochemicals Data Analses Serum PFOS and PFOA levels were the predominant fluorochemicals as the other five analytes were measured at considerably lower levels (Olsen et al 2001b; 200Lc); therefore. PFOS and PFOA were the only two specific fluorochemicals analyzed as explanatory variables in regression models. TOF was also considered in the analyses which took into account these other analytes in an aggregate index (see above definition). Descriptive simple and stratified analyses, Pearson correlation coefficients, ANOVA and multivariable regression were used to evaluate associations between PFOS, PFOA and TOF and each hematological and clinical chemistry test and thyroid hormone assay. For stratified analyses, employees were divided into quartiles of their serum PFOS 000143 Pa3gMe C1o2m0pfa1n2y1 distribution. Age, body mass index, current alcohol consumption (drinks per day) and cigarette use (cigarettes smoked per day), years worked at Antwerp or Decatur, and type ofjob (production versus non-production) were potential confounding factors that were considered in the analyses. Production jobs included cell operators, chemical operators, mill operators and crew supervisors. Non-production jobs included engineers, QA/AC laboratory and research workers, secretaries and managers. Multivariable regression models were fitted with PFOS and/or PFOA analyzed asa continuous variable(s). Significance of coefficients was considered at p < 05. Natural log transformations of the dependent variables were performed, when necessary, to normalize variables and to enhance model fit. Study results were analyzed using the SAS System (1990). RESULTS . Altogether. there were 255 Antwerp employees (206 male and 49 female) and 263 Decatur employees (215 male. 48 female) who participated in the 2000 fluorochemical medical surveillance program (Table 1). Seventy three percent of the Antwerp male employees and 75 percent of the Decatur employees worked in production activities. "Only 12 percent of the Antwerp female employees worked in production activites compared to 63 percent of the Decatur female employees. Provided in Table 2 are the mean PFOS, PFOA and TOF values, demographic values and clinical chemistry and thyroid values for male employees stratified by location and production or non-production work activities. Regardless of the production categorization, Antwerp male employees compared to Decatur employees had lower 000144 Pa3gMe CIo3m0pfa1n2y1 serum PFOS and PFOA levels; were significantly younger; had lower mean BMI; worked fewer years; drank, on average, more alcoholic beverages per day; had higher mean HDL and total bilirubin values; and had lower mean triglyceride, alkaline: `phosphatase, GGT, AST and ALT values. Mean thyroid hormone values tended to be higher among Antwerp employees. All mean values were within reference ranges. Comparable findings were observed for Antwerp female employees comparedto Decatur female employees (Table 3). Given the differences between Antwerp and Decatur employees, univariate: analyses were initially stratified by location. Antwerp data, stratified by gender and production, are provided in Tables 4 through 12. In a similar fashionDecaturemployee data are provided in Tables 13-24. The Decatur data also include employee urinalysis results. Antwerp production male employee data (n = 150), stratifiedby quartile of serum PFOS distribution, is presented in three sequential tables for clinical chemistry (Table 4) and thyroid hormones (Table 5) and hematology (Table 6) results. The highest quartile (4*) mean serum PFOS level was 2.61 ppm (range 1.76 - 6.24 ppm) compared to the Towest quartile (1) mean serum PFOS level of 0.29 ppm (range 0.04 - 0.41 ppm). Production workers in the highest quartile of serum PFOS levels were older and worked more years at Antwerp. There were no significant mean differences between the quartiles for BMI cigarettes smoked or drinks per day. There was only one significant difference between the four quartile levels for any clinical chemistry. thyroid hormone or hematology comparisons. This significant difference was the comparison of the mean BUN value between the 1 and 3 quartiles. 000145 Pa3gMe Cloomfpa1n2y1 In a similar fashion for the 56 non-production Antwerp male employees, their clinical chemistry, thyroid hormone and hematology results are presented in Tables 7, 8 and 9, respectively, for their quartile distribution of serum PFOS. In this analysis, the highest quartile had a mean serum PFOS level of 0.90 ppm (range 0.49 - 1.76) compared. to ameanof0.13 ppm (range 0.05-0.20 ppm) in the lowest quartile. No significant mean differences were observed for demographic (Table 7), clinical chemistry (Table 7), thyroid hormone (Table 8) or hematology (Table 9) comparisons between the serum PFOS quartile distributions. Among the 49 Antwerp production and non-production female employees analyzed as a group (Table 10), the highest quartile mean serum PFOS level was 0.26 ppm (range 0.15 -0.55) compared to the lowest quartile mean serum PFOS level of0.06 ppm (range 0.04 - 0.08 ppm). The highest serum PFOS quartile did not significantly differ demographically than the other three quartiles (Table 10). The lower three quartiles had some significant differences between themselves for the mean comparisons of years worked and drinks per day. Only one clinical chemistry. BUN, was significantly different between the quartiles as the 3 and 4" quartiles had higher mean BUN values than the 1* quartile. All mean values were within reference ranges. No significant mean thyroid hormone (Table 11) or hematology (Table 12) difference was observed between the quartiles. A total of 161 Decatur production male employees were stratified based on their quartile distribution of serum PFOS (Table 13). The highest quartile had a 3.22 ppm mean serum PFOS level (range 2:31 - 10.06) compared to 0.55 ppm mean serum PFOS level in the lowest quartile. There were no significant mean demographic differences 000146 Pa3gMe C1o5mopfa1n2y1 between the four quartiles and the only clinical chemistry test that was significantly different was ALT (Table 13). The highest quartile had a significantlyhigher mean ALT level (44 IU/ml) compared to the 1 (33 TU/ml), 2* (32 TU/ml) or 3" (33 IU/ml) quartiles. There were no significant mean differences for the Decatur male production employee quartile distributions for thyroid hormones (Table 14), hematology (Table 15) or urinalysis (Table 16) results. Among the 54 Decatur non-production male employees (Table 17), their highest quartile mean serum PFOS level was 1.6 ppm (range 1.00 - 2.95 ppm) compared to the lowest quartile meanof0.19 pp (range 0.06 - 0.29 ppm). The highest quartile worked almost twice as long as the lowest quartile (Table 17). There were no significant differences in other demographics, clinical chemistries (Table 17), thyroid hormones (Table 18), hematology (Table 19) or urinalysis (Table 20) results among the quartile: distributions. I" Among the 48 Decatur production and non-production female employees (Table 21), the highest quartile had a mean serum PFOS levelof 2.04 ppm (range 1.38 - 3.62 ppm) compared to the lowest quartile mean serum PFOS level of 0.20 ppm (range 0.06 - 0.31 ppm). There were no significant differences between the quartiles in relation to demographics (Table 21), clinical chemistries (Table 21) or thyroid hormones (Table 22). The third quartile had a significantly lower mean platelet count than the 1* quartile: (Table 23): however, the fourth quartile was not significantly lower than the 1 quartile. Urinalysis findings did not differ by quartile (Table 24). Presented in Table 25 are the number (and percentage) of Antwerp or Decatur employees which had above reference range values for hepatic clinical chemistry tests. 000147 Pa5gMe Clo6mopfa1n2y1 These findings in Table 25 are stratified by serum PFOS quartile distribution within each of the gender and production/non-production categories. Because each sub-population has a different serum PFOS quartile distribution, comparisons should only be done within each location-, production- and gender-specific category. Also presented is the number and percentageof employees who had one or more liver enzyme and bilirubin tests above the reference ranges (see aggregate total liver panel). The percentage of Antwerp employees whose liver enzyme tests were above reference range values was comparable for production and non-production male employees. Among Decatur employees, there was a higher percentage of production male employees in the 4" quartile for ALT, GGT and the total liver panel than the other quartiles. For non-production male employees, the highest percentages occurred in the second or third quartiles. Neither Antwerp or `Decatur female employees had percentages consistent with any trend in the quartile distributions. Provided in Tables 26 and 27 are the serum PFOS quartile distributions for the combined 421 Antwerp and Decatur production and non-production male employees. `The highest quartile (4) had a mean serum distributionof2.69 ppm (range 1.69 -- 10.06 ppm) compared to 0.27 ppm mean (range 0.04 0.42 ppm) comparetod the lowest (1) quartile distribution. It is important to note that the number (and percentages) of Antwerp versus Decatur employees in each of these four quartiles differ (see footnote to Table 26). In the lowest (1) quartile, there is a greater percentage of Antwerp than Decatur male employees and more non-production than production employees. In the subsequent higher serum PFOS quartiles, the percentage of Decatur production male employees increased and the percentage of non-production male employees, whether 000148 Pa3gMe C1o70mfgn12y1 from Antwerp or Decatur, decreased. These differences were also reflected in the demographics between quartiles. For example, demographically the trend from the lowest to highest quartile increased with age, BMI and years worked and decreased with the `mean number of alcohol drinks per day. Likewise, the means of the clinical chemistry and thyroid hormone tests were reflective of the higher percentage of Antwerp employees in the lower quartiles and higher percentage of Decatur employees in the higher quartiles. Mean triglyceride and alkaline phosphatase. levels were lower and total bilirubin levels were higher in the lowest quartile compared to the highest quartile. Forthyroid : hormones, T3 was lower in the 1" quartile compared to the 4" quartile and THBR was significantly higher. Combined analyses of Antwerp and Decatur production and non-production female employees (Tables 28 and 29) presented asimilardistribution of employees by location and production pattern as was observed with the production and non-production `male employees (Tables 26 and 27). Antwerp female employees predominated in the lowest quartile and Decatur female employees predominated in the highest quartile. This distribution difference is then seen with the lower mean age, BMI and alkaline `phosphatase findings and the greater number of drinks per day and higher total bilirubin levels in the lowest quartile compared fo the highest quartile. Also observed was a lower mean GGT and blood glucose level in the lowest quartile when compared to the highest quarile. There were no thyroid hormone differences between the quartile distributions (Table 29). `Summarized in Table 30 are the combined number of Antwerp andDecatur `employees (and percentages) who had hepatic clinical chemistry tests above reference 000149 Pa3gMe CIo8m0fpa1n2y1 range values stratified by quartile of the serum PFOS distribution. Among male employees, twelve percent of the employees had above reference range values for ALT and GGT in the 4 quartile compared to 4 to 8 percent in the 1* through 3 quartiles. For the total liver panel, 23 percent of the male employees had one or more liver clinical chemistry tests above the reference range value comparedto 14 to 16 percent in the lower three quartiles. No differences were observed within the female employee population. These percentages were not adjusted for potential confounding factors (e.g, BMD. `Because the higherliver enzyme function test results in the 4 quartile might be confounded by demographics (higher BMI, older age) and/or clinical chemistry tests (triglycerides) reflective of dietary differences, multivariable regression analyses were conducted on the combined Antwerp and Decatur male employee participants. Each regression model had the following variables: production job (ye=s 1; no = 0); . Antwerp/Decatur (1 = Antwerp; 0 = Decatur): age, BMI, cigarettes per day, drinks per day and years worked. For the analyses that involved hepatic clinical chemistry tests, triglycerides was also considered a potential explanatory variable. Regression models analyzed serum PFOS, serum PFOA, serum PFOS and PFOA, and total organic fluorine: (TOP). Provided in tables 31 through 34 are the analyses for these fluorochemical comparisons in relation to their effect on cholesterol. adjusted for the other explanatory variables. Serum PFOS was positively associated with cholesterol although its explanation of the variability of cholesterol in the model was less than | percent (see partial R). (Note: This positive association is opposite that of the well-established negative association between serum cholesterol and PFOS that have been shown to occur 000150 Pa3gMe C9omopfa1n2y1 in toxicological studies at threshold serum doses that were approximately 2 orders of magnitude higher than those serum PFOS levels observed in these employees.) Like PFOS (Table 31), there were positive significant associations each for PFOA (Table 32) `and TOF (Table 34) with cholesterol but the model thatjointly examined the effects of PFOS and PFOA found neither to be significant (Table 33). Again, this is contrary to the toxicological research that has shown PFOA lowers serum cholesterol. Age and drinks per day were significant variables in the model with cholesterol. PFOSand TOF were not significantly associated with HDL, but PFOA was significantly negatively associated (Tables 35 through 38). As to be expected, BMIand drinksper day were strongly associated with HDL. Analysis of triglycerides showed PFOS, PFOA and TOF were: positively associated (Tables 39 through 42). PFOA appeared to be the more significant predictorthan PFOS. (Note: PFOS and PFOA have decreased serum triglyceride levels at toxicological doses, not increased serum triglyceride levels.) Age, BMI and cigarettes smoked per day were significant variables in the triglyceride models found in Tables 39 through 42. Provided in Figures 1 through 3 are scatter plots of the simple linear regressions between the natural log of serum triglycerides and PFOA for Antwerp male, Decatur male and Antwerp and Decatur female employees. Multivariable regression model results for the hepatic clinical chemistry analyses are found in Tables 43 through 62. Because of the potential confounding positive: association with serum triglycerides, this variable is added to these models. No significant associations were observed with PFOS, PFOA and TOF in relation to alkaline phosphatase (Tables 43 through 46), GGT (Tables 47 through 50) or AST (Tables 51 through 54). Although PFOS or PFOA were not significantly associated with ALT 000151 Pa3gMe C2o0m0pfa1n2y1 (Tables 55 --57), TOF was positively associated with ALT (Table 58). PFOS, PFOA or TOF were not significant predictors of total bilirubin (Tables 59-62). Multivariable regression analyses of the thyroid hormones resulted in no significant associations of PFOS, PFOA or "TOF with TSH (Tables 63 - 66), T4 (Tables 67-70), Free T4 (Tables 71 - 74), THBR (Tables 75 -- 78)orFTI (Tables 79- 82). PFOS, PFOA and TOF were positively associated with "T3 although contributed `minimally to the variation explained in the model (see partial RY). DISCUSSION Although voluntary participation rates ranged from 53 percent (Decatur) to 75 percent (Antwerp), the 2000 fluorochemical medical surveillance program had the most (in absolute numbers) employee male and female participants ever for both locations. "This is likely due to a combination of factors including 1) greater knowledgeofthe collective (individual and research) value of the fluorochemical medical surveillance `program: 2) employee awareness about the persistence and prevalence of PFOS in human tissue and the environment: and 3) the company's May 16, 2000 phase out announcement that it would cease production of perfluorooctanyl chemistry in certain repellents and surfactants by the end of 2000. Serum PFOS and PFOA levels were comparable to those previously reported for employees at these manufacturing operations. Serum levels appeared to be log normally distributed with the highest values for PEOS at 10 ppm. This upper tail of the serum PFOS distribution was also reported in a random sample analysis of Decatur employees conducted in 1998 (Olsen et al 1999b). Separate reports examine the employees' serum 000152 Pa3gMe C2o1mopfa1n2y1 PFOS, PFOA, PFHS, PFOSAA, M570, PFOSA andM556 levels measured in the 2000 fluorochemical medical surveillance program with their workplace operations in Antwerp. (Olsen et al, 2001b) and Decatur (Olsen et al, 2001). We continued to observe consistent differences between Antwerp and Decatur `employees regarding their demographics and lifestyle differences. In particular, Antwerp `male employees, on average, were younger (and thus worked less), had much lower 'BMIs and drank more alcoholic beverages than their Decatur counterparts. All three: differences can be important confounding variables when analyzing lipid and hepatic clinical chemistry tests. We have also consistently seen higher total bilirubin values. among Antwerp employees since 1995 which may be partially attributable to a greater prevalence of Gilbert's syndrome (Olsen et al 1998; 19992). An inconsistent finding from these aggregate analyses was the positive associations in the multivariable models reported between PFOS and serum cholesterol and PFOA and serum cholesterol and triglycerides. There is a substantial body of toxicological literature to suggest these associations are spurious because PFOS (in rats and primates) has been reported to decrease serum cholesterol and triglyceride levels (3M Company 2000; Haughom and Spydevold 1992; Ikeda et al 1987; Pastoor etal 1987; `Seacat et al 2001a; 2001; Sohlenius et al 1993). On theother hand, there is inconsistent evidence for hypolipidmia with PFOA in rodents (Pastoeotr al 1987; Haughom and Spydevold 1992) and no effect observed in primates (Butenhoff et al 2001). In primates, there was no association observed between PFOA and cholesterol or triglycerides (Butenhoff et al 2001). There is no toxicological evidence that at the serum PFOA levels observed in our medical surveillance program that PFOA would have resulted in 000153 Pa3gMe C2o2m0pfa1n2y1 hyperlipidemic associations. In addition, the PFOA levels observed among Antwerp and Decatur employees in 2000 was lower than those measured in 3M's Cottage Grove manufacturing employees whose serum PFOA levels have been assayed as high as 100 `ppm. Hypolipidemic or hyperlipidemic effects have not beenassociatedwith serum PFOA levels among these Cottage Grove employees (Gilliland and Mandel 1996; Olsen etal, 2000). Most recently, the 2000 Cottage Grove fluorochemical medical surveillance: `program analysis again showed no association between serum PFOA levels and serum cholesterol or triglycerides (as seen in Figure 4). (Note: The serum PFOA levels `graphed in Figure 4 are substantially higher than those cited in Figures | through 3 for the Antwerp and Decatur male and female employees.) We therefore believe that its highly unlikely that these are causal associations observed in the 2000 fluorochemical medical surveillance data between PFOA and serum cholesterol and triglycerides. Previous toxicologicalandepidemiological research has also not suggested positive associations between elevated serum liver enzymes results and serum PFOS or PFOA that were at the levels observed in the Antwerp and Decatur employee population (3M Company, 2000; Butenhof? et al 2001; Gilliland and Mandel 1996: Olsen et al 19984; 19993; 2000; Seacat et al 2001a; 2001b). In this 2000 fluorochemical medical surveillance program we observed. among Decatur production employees, a significantly greater mean ALT among those workers in the highest serum PFOS quartile distribution compared to the other three quartiles. This highest quartile of Decatur employees also had the greatest. percentage of employees with ALT (28%) and GGT (15%) values above the reference range as well as the total liver panel (35%). A comparable percentage (36%) was observed among Decatur non-production employees in the second lowest 000154 Pa5gMeC2o3mopfa1n2y1 quartile withoneor more hepatic clinical chemistry tests above the reference range. `When male employees were combined by production status and location (as seen in Table 30), we reported an upward trend in the percentage of employees in the highest quartile with values above the reference range for ALT (12%), GGT (12%) and total liver panel (235%). However, after adjusting the employees' individual liver function values by `potential confounding factors including age, BMI, number of alcoholic drinks per day, cigarettes per day and serum triglyceride values, we found no association between liver function values and PFOS or PFOA. We therefore suspect that the univariate: associations were influenced by known confounders of liver function analyses A battery of thyroid hormone tests were included in the 2000 fluorochemical `medical surveillance program due to preliminary, albeit biologically inconsistent, findings in toxicological studies that have yet to be completed. Our surveillance data do not suggest any biologically significant associations between thyroid hormones and employees' measured serum PFOS, PFOA or calculated TOF levels. A retrospective cohort mortality study of Decatur employees from 1961-1997 reported 3 deaths from bladder cancer compared to 0.2 expected in the subgroup of workers with the highest potential exposure to perfluorooctanesulfonyl fluoride (POSF)based chemistry and materials (Alexander 2001b). It was not determined whether this association was fluorochemical-related or possibly due to other non-fluorochemical occupationalor non-occupational exposures. An analysis of episode of cares (Olsen etal 20014) reported a higher reoccurrence of cystitis among female Decatur chemical plant workers than their counterparts in the film plant although the actual prevalence of unique individuals with episodes of care regarding cystitis was similar. No differences were 000155 Pa3gMe C2domopfa1n2y1 reported among male chemical and film plant employees. The analysis of these 2000 fluorochemical medical surveillance data showed no association between the prevalence: of abnormal urinalyses and employee serum PFOS levels among the Decatur employees. Limitations of this study design include its cross-sectional nature which does not adequately allow for the assessment of temporal changes. However, the large `participation ofemployees in 2000 who may have participated in the 1994/95 and/or 1997 fluorochemical medical surveillance programs at these two manufacturing sites has enabled a longitudinal analysis to be performed. This longitudinal analysis s the focus of aseparate 3M investigation (Olsen etal, 2001a). Although stil very limited in numbers, we were able to provide separate cross-sectional analyses for female employees, for the ' first time, which showed no biologically relevant associations between serum PFOS andlor PFOA levels with clinical chemistries, thyroid hormones or hematology results. Because 3M has announced a phase-out of the production of perfluorogctanyl chemistryrelated materials, we anticipate that the Antwerp and Decatur employee population mean PFOS and PFOA serum levels should be lower when measured during the next fluorochemical medical surveillance program. These future analyses may be hindered by the fewer employees in the workforce as a consequence of the phase-out announced by the company. Another study limitation was the lower serum PFOS and PFOA levels measured among these employees compared with those suspected to cause effects in laboratory animals. In summary, the findings from the 2000 fluorochemical medical surveillance program continue to suggest that Antwerp and Decatur fluorochemical production and non-production employees do not show substantial changes in serum hepatic enzymes, 000156 P3agMeC2o5mofpa1n2y1 cholesterol, or lipoproteins associated with the serum PFOS and PFOA levels measured. A separate longitudinal analysis is reported for the fluorochemical medical surveillance Antwerp and Decatur program data from 1994 through 2000. ACKNOWLEDGEMENTS `The investigators acknowledge the contributions of Kimberly Young in the prepartion of this report. 000157 Pa3gMe C26omopfa1n2y1 REFERENCES 3itsMsaCltos.mpSatn. yPa(u2l00(0M)N.)S:I3DMSCIonimtpiaalnays,se(susnmpeunbtlirsehpeodt:rPeeprof)l.uorooctane sulfonic acid and fAalceilxiatny.deMrinBnHea(p2o0l0i1s2)(.VINM)o:rUtnailvietryssittuydoyfoMfiwnonrekseortsa,em(punlpouybeldisahtetdhree3poMrt)C.ottage Grove MAilnenxeaanpdoelriBsH(M(N2)0:0U1n6i)v.erMsoirttyaloiftyMisntnuedsyootfa,wo(rukneprusbleimsphledoyreepdoratt).the 3M Decatur facility. BLiuetdeenrhoPf,fOJlLs.enCoGsWta,GT,hEolmcfoomrbdePC.,TFoaxrircairtDy,ofHaanmsmeonnKi,uImwapierHf,luJournoogcRt,anKoeatnene(dAyPFGO,) in cynomolgus monkeys after 26 weeks of oral dosing. St. Paul (MN):3M Company, (unpublished report) Gilliland FD, Mandel JS (1993). Mortality among employeesof a perfluorooctanoic acid production plant. J Occup Med 35:950-954. GliilploiplraontdeiFnDs,anMdanchdoellesJtSer(o1l:99a6)s.tuSdeyroufmocpceurpfaltuioornoaolcltyaneoxipcoasceidd maennd.heApamtiJc IenndzyMmeeds, 129:560-568. q`uHaanntsietnatKiJv.e CclhaermaectnerLiAz,atEilolneoffsoonrgMaEn,icJfolhunosroonchJeHmiOca(l2s00i1n)b.ioCloomgipcoaulndm-atsrpiecceis.ficE,nviron Sci Technol 35:766-770. - pHearuflguhcoocmtaBn,oSicpaycdied v(oPlFOOdA()1.99p2e)r.fluTohreocmteacnehsaunlipshmonuincdeacrildyi(nPgFtOhSe Ah)ypaonldipcelomfiicbreifcfeacctido.f Biochemica et Biophysica Acta 1128:65-72. cIyktedoachTr.oFmuekPu-d4a5K0.aMnodrpierI,oEinxoommeotproolMi,feKraotmiaoniiTn,raStulgiaveTr b(y19p8e7r)f.luIonrdiuncattieodn of octanesulfonic acid. In: Perixosmes in BiologyandMedicine. (HD Fahmi and H Sies, eds) New York: Springer Verlag, pp 304-308. COllisneicnalGcWh.emiBsutrrriiessJ,Mh,emMaatnodleolgyJHa,nZdohboerlmLonRe(s1i9n98rae)l.atiAonnteopsideermuimolleovgeilcsionfvestigation of perfluorooctane sulfonate in male fluorochemical production employees. St. Paul:3M Company (unpublished report). eOplisdeenmiGoWl,ogGiiclliinlvaensdtiFgDat,ioBnurolferwepMroMd,ucBtuirvreihsoJrMm,onMeasndienlmeJSn, wMiatnhdoeclcuJpHat(i1o9n9a8lb)e.xpAosnure to perfluorooctanoic acid. JOEM (40(7):614-621. 000158 Pa3gMe C27o0mfpa1n2y1 OalnsdehnepGaWti,c BaunrdrilsipJidM,clMinaincadlelchJeHm,isZtorbyeltesLtsRi(n1f9l9u9o)r.ochSeemriucmalpperrofdluucotrioooncteamnpelsouylefeosn.ate JOEM 41(9):799-806. OMlasnednelGWJH, (L1o9g9a9n)P.WF,luSoirmopcshoenmiCcAal,eHxapnosseunreKJa,ssBeusrsrmisenJtMo,fBDuerclaetwurMcMhe,miSccahlumapnedrftilJmC, plant employees. St. Paul:3M Company (unpublished report) OhlepsaetnicGeWn,zyBmuersr,iscJhoMl,esBtuerrollewanMdMl,ipoMparnodteeilnsJiHn (a2m00m0o)n.iPulmaspmerafclhuoorloeoccytsatnookaitnen and production workers. Drug Chem Toxicol 23(4):603-620. Olsen serum GW, Burlew MM, Burris perlfuorooctanesulfonate JB, Mandel (PFOS) and JM (2001a). A longitudinal perfluorooctanoate (PFOA) analysis levels in of relation t1o99l4ip/i9d5,an1d99cl7inaincadl2c0h0e0mifslturoyrotceshtemreiscualltsmfedriocmamlasluerveemiplllaonyceeeppraorgtriacmip.anStts.oPfautlh,e MN:3M Company (unpublished report). JOlKs.eMnaGndWe,lSJcHhm(i2c0k0l1eb)r.MNDe,scTriieprteinvseJsMu,mmLaograynofPWse,rBuumrrfilsuoJrMo,chBeumrilcaelw lMeMve,lsLaumnodnbgerg employee program. pSta.rtPiaucli:3pManCtsoomfpthae nyeyar(2u0n0pu0bAlinsthweedrrpepfolruto)r.ochemical medical surveillance: (O2l0s0e1nc)G.WD,esLcorgiapntiPveW,suSmimmaprsyonofCsAe,rBuumrrfilsuoJrMo,chBeumrilcaelw lMevMe,lsLaumnodnbgeregmpJKl,oyMeaendel JH `participants of the year 2000 Decilur fluorochemical medical surveillance program. St Paul:3M Company (unpublished report). OeplisdeenmiGoWl.ogiBcuralneawlyMsiMso,fHeopciksiodnegsBoBf,caSrkreaotft 3JCM,DBeucrartisurJMc,heMmaincdalelanJdHf(i2l0m01p4l)a.nt An employees. 1993-1998. St. Paul MN:3M Company (unpublished repory). PStausdtioeosroTfP,amLmeoenKiPu,mPeprerrifMluAo,roGoicltlnioeastPe-Ji(n1d9u8c7e)d.heBpiaocthoemmeigcaally aanndd mpoerrpohxoilsoogmiecal proliferation. Exp Mol Pathol 47:98-109. SAS Institute, Inc. (1990). SAS Users Guide:Statistics Version 6. Cary, NC:SAS Institute Inc. SSeuabc-acthrAoMni,cTdhieotmafryortdoxPiJc,itHyaonfspeontaKsJs,iCulmepmeerfnluLoAr,ooCcatsaeneMsuTl,foBniuctaecnihd oiJnfLrfats(.20T01oax)i.col Sci (submitted 2001a). `tSoexaiccaittyAsMt,udiTehsoofnorpderPfJl,uHoaronoscetnanKeJs,ulOflosneanteGpWo,taCsassiuemMsTal.t BinutceynnhoomfoflJgLu.sSmuobnckheryosn.ic Toxicol Sci (submitted. 2001b). 00159 Pa3gMe C28omopfa1n2y1 Sohlenius AK, Eriksson AM, Hogstrom C, Kimland M, DePierIrWe (1993). aPenrdflotuhoerrooaccttaivnietiseuslfkonnoicwnactiodbies aafpfoetcetnetdibnydupceerrooxfispoemreoxpirsoloimfaelraftaotrtsyiancimdoBu-soexildivaetri.on Pharmacol Toxicol 72:90-93. 00160 - i. 1 Numbeorf Employee Participants in the 2000 Antwerp and Decatur Medical Surveillance Pograms 000161 ros veon or ae a Yours Worked Cipeteciny Dinky Chosen io Tryesies re car ast nr faeCtomipdu Tae Mean ValDu foreMalemFnpColhoyeeags PCahiecmeihrsessSiaenrduTmohyFrsooinrdoRch.cemicl Levels e ET M DIET ont Lo Lo Lar 26 I a ux ms " 6 . " w or an 215 o " ne w " a a" ES 0 = PN AREP)okeDem ONT) we wo wn a wo as 0 a ust 29 w 1s s . ww w ais wn ss a ne 1s Ca nt a x o 2 N Aep=e 50_ t Decur(i i=30 on on oa os ast on wo P 52 me is 2 2 s ww 0 ns wm ss P 2 0 @ @ = u 2 a 000162 | "Table (ontinucd) Total Bilin ww 01 0 or Dire ili or or or or nox w is wt is Creatinine [ fn ue 12 Glucose a 95 " os Toi 20 29 20 a TM 5 8a 5 " Freed we fn we 1 Ek we ns nr m HBR a a w EF) Fm 27 2s ar 25 *9p<<..0018 ccoommppaarreeddttooDDeeccaattuur r(1ttesets)) <#pP<<..0000011ccomopmapraerdedttooDDeeccaattuurr(t1 ette)s) raSeM3Cioalmp21a we os 0 or wt 1s 12 u a " 1 2 a is 1 5 ns 2 ss a ar 25 000163 Table 3 Mean Values for Female Employee Participants' Serum Fluorochemical Levels, Demographics, Clinical Chemistries and Thyroid Results PFOS PFOA TOF Age BMI Years Worked Cigarettes/day Drinks/day Cholesterol HDL Triglycerides Alk Phos GGT AST ALT Total Bilirubin Direct Bilirubin BUN Creatinine Glucose TSH T Free T4 kel THBR FTI Antwerp (N = 49) 013 007 oar 36 2.8 2 2 0s? 208 68 94 46 12 18 13 0s ot 16 09 85 23 102 Lr 148 30 29 Decatur (N = 48) 093 123 176 a 217 13 5 0.1 200 59 133 65 18 20 19 06 ol 2 08 87 23 93 10 128 2 25 2p <.05 compared to Decatur (studentt test) P <<..00101cocmopmapreadrtetodoDeDceactautrur(s(tsutduedntentttetsets)t) p <.0001 comparedto Decatur (studentt test) 000164 Pa3gMe C32o0mfpa1n2y1 | Tabled F5MeCaomrpanny Flaoroshenical, DemographiAcvnedryClMiiecPCrhoednuicstiiornyERmepsluolsyebsy(QNu=a15r0)otfSielruem PROS Diistibution i equeien maic 0S 0230e Wn uiuiecpte$30n, Fog Wu MQeuinieSon Ra or ome om an amon ase aw am ea-am LW 6 om mole 26 am les te-ex mon os am oman Is om Im oman I! 10 00 0N-H Le le on axes or wae om omom 1G en 13 ease A 0% Imo SP 1a wines ne wow 7 mw ww a ms wo % 0 ms ww x ws ma a0 me a mama we ws A mews we 2 2 BSE M3 M1 20 namo Yow #45 6 am mw a pay 3 0 1 em so 4 amo on om 4 0 & mw om 1 se 01 sw on Duy Coed 12 10 1 mw ea woes 1 We 0 da a4 ee ams 0 01 mw We a om oem uo mem 1a es mew wm mets 8 om mas me ow wm em ms nm wm ese ws on mm Mo mm ami man ww mks ew MR @ 6 5 ues @ @ nm wm $B ww a @ uo uw rw wm ms wm ow sr mu + bes ow mos aw ww om Bu moa 5s ew mm 3 Bn mom 6 1 5 wr on Taba 10 om ow wm 10 0 Gels om 10 om a aa wa eso moms 10 M63 sw 01 mm 0 9 ew wo een Diabiote 01 01 wv wn oa soa 4 mes OI 4 Lo wom 4 Go mmo a1 om 01 6m 002 Bs wm a1 0 mB a 00-04 4 un TT TT =SL ICI Gwe mmm wen wm wean Hompct iat <5Boredtom met rte wm 8 un _ Sw ww em -- i si dill P< 05 Buc (Duan) st)fon hemenof he 2 arte 000165 | | ives r3aMgCoemdpa1n2y0 | ThyroiAdnRtewseurlips*MlbyeQPurarotdiulcetioofnSEermupmlPoRyOe(SNeD=is1t5r0i)bution iin Qpuedee 4S3o)ngs Mon QMueidtaen2 4S2O38) Tame Ed 516 mows? 20 20 09 038s TM 52 83 1S SACS 85 Be 14 66-20 BeTM 12 Ww 02 031s LLL 01 Goel mm wm as sss Be m0 ee mER WM 3 m0 MM 2 B m 2 26 05 21-42 28 38 04 20-40 nm sc #N05o gTanblce foiserrumeFtOS<q0u,alB e disa bi(oDnut n) c)e meann vcs _V_eQruaMekda3ngiS=D i Wangs 20 17. LL 08-61 52 BI 14 S0-US LL 4 02 06-6 mm 1 Sm MM 3 ma 21 21 04 19-39 Wem QMeduiaen 4S2O31) Tange 22 16 30 05-m4 EL 82 44 47-10 HL 03 0-ig 86 m2 9s HH 1 pea 27 20 04 16-36 reot6s Tinh P3agMeC3o5m0p0a12n1y HematoloAgnyiwReerspulMtlsebyPrQoudaurcitlieoonfESmeprlumoyPeR(ONeS=Di1s5t0i)bution** Vin QMeudaen 0S40231) Wage WemMeQdaune S2O230 Tome TE HOB iss 14 08 Mo-;4 Iss ISS 09 DAED mec sa sa 03 46-s9 SI 52 03 44-$9 WBC 70 a4 18 42-ma 23 ULE 44-US Paes 2 20 DW 2s 20S 0 C NogA afserS cumFOS< T 0c5u,rBlodsfE eiruos (nDv) es men ues Wem QMeudaen =SD) Wangs Men QMeudain eStO ) Wangs RE ISA ISS 08 B6-n3 13 183 09 DA-in SI SI 03 43-59 50 so 03 40-58 76 74 16 sa-lu 12 69 21 4S-1S6 9 2B eee was 19-30 eee? | tner re 50 ummgs tie, Ee ifcm RCSDt mam meenn aRarNon _-- oe ven won ap waa om on en sees ea on oo oun ee nM mh We moma am om os on ww mtgfer < 5Beerrd(un) tf hf 7ute reosen icSioorp | Table 8 Pe hyAdntwRerepnMslbeyNoGnorroeduocfiSoneEmpPFeOSsDi(s=but56ent ] 7gue 01210 l quai 200-1: ql uest19 PO a Tw a uw sea wwe a es a6 0 ome 2 16 14 loa Www wee amt as sess womb ss 9 m1 aie TT TH Sp Bow mow mew moon mew mo me 3 sa ms mw pow mm oa a 2m wwomwowwem x 3 4ewmeesw 3 ow 3 wea 1 ome was s2u mea wwe ew S platy fc R Boro vn) cs | | 000169 --_ PameCormpainy HematoloAgnytRweesrupltMslebyPQruoadrutcitlieoonfEempulmoyePeRO(NS =Di4s9t)ibution** Vii QSaudaen1 4S=b10) Tange Wien MQeudainte S2b413) ange Wen QMueesas iS=b19 ange Wem QMuadtmie 4S4O1) Wane WT Mw 2 wes 0 1 ae 463 ass 6 4 2 4% HOB isi 10 11 R2-m0 Ise USS 07 MIS S413 08 MO-M0 153 1S) 08 Mi-ii REC si Si 02 4s-se SI S103 46-56 si S103 45-7 So S003 47-55 WBC 66 64 13 si-l01 6 65 17 47-07 65 60 21 3-L0 65 64-13 49-96 BeEe me mr 6 pmse 20 m0t MIe ms mS--m-- ens--3---- m0-- emua s N3o5agaabentfo dsiefreurmenFt O<S0q,lBedirsnsiDunne) 1)mesvlc 000170 Tale 10 mr FlaorochemAinctawle,rbpeFmeomgarluepPircodnucdtiColninicaanldCNhonr-iPsrotdeucRteisoulntsEbmypQluoayte(lNeeo=fS4e9r)um PFO. Tosa | os S SooE m oonE ow-0x rox wn om om os-os or ow 0 mason I now x wm ne mens me mews Cass 1 0 3 ew bewdy 0P 01 0 oes Cool Ns Ws 0 sos wou @ 0 ws moa Wm 9 km Mme $s 4 mw 00 EGEm om 0B Gm on om on on x ws ms me 2 ET 1 00 0 0s 00 wm 6 mom ow Bn 0m 4 a Ww om-ow S on an e om Soon ome on om om om-om Goon om an om apo ma mo % 5 ua gem wom 46 mon om 2 os ous won od or oe Gis mem wo wm won wm @ a ow eee 2m wm wm pew 8 wm wa a oud on 0x om 0W ax ow % wb m0 on 015-05 03 wen au ono wa 0 Wx 20 ass ww ma ww aa 4 on 0s 0ieke neem 6 ow a mm uw mw asT nr EI) 5 Men Wom o eso non omom s oa EY won ams 6 9-2 7 ex n i" ow ow 6 nen 3 aw cor pol oh am wo ms am wml a ww 4 sn basa 08 0 02 aso2 le Go 03 esa en 08 0 mo 01 01 m2 02 Drama a1 01 om on-z @ a am aac or or 0 os-e2 ol ol a0 olor wn Won a ew sw 3 wm wow 4 sm Ww 3 nes Cots Gm 00 00 wr wel mw ww 00 G0 wen Mw neem 10 dea ee ew u__ew low own mw new enrol nOsGee at Mead recea b5Drocne Dueetenvefmsootm e meemree ttlele ee34 A 4 000171 . eter Fu3gMeCdo0m0p1a1n3y1 Antw"eTrhpyrFoeimdaRleesPurlosducbtyiQounasrtnidleNoofnSePrroudmucPtiFoOnSEmDipslrobyuetei(onN=* 49) Qutte104212) ge TH 20 15 14 ome 3 7 3 22 ee-;s met LM on Onin mm te ees mR mms mem m 2s 29 0s 21-36 Wein MQeduane2 SO= 1) ame 24 24 10 06-41 97 97 18 69-3. 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An`tHweemraptoFleomgaylReePsruoldtusctbiyonQusanrdtNiloeno.fSPerorduucmtiPoRnOESmpDlisotyiebeut(iNo=n*4*9) Pag30eCloamrpian]g CV_ieQn ubaeaimSnDemWa| ge _Q_Wa_un uMeea5t(0 iNT_oenng_me _Q_W_aurn uMekdadiSD =T_dong_)e _Q_Meum eVekdondSb eTdoe) WT ew 4 mea a a 3 Wes 0 a 2 dew a a 2 ue HOB 03 Be 1s 94-us 1S DS 07 SISO B53 D3 08 MI-MS BS De 08 ns-is | mee a6 47 es west as 4s 0) a-Si 45 43 02 4250 45 4s 03 asm WBC 27 74 19 48-0 63 60 17 3993 13 92 14 S405 65 63 13 44-04 mals 26 M6 0 mem ms Wm Wm WB @ meas MW 20 6 leas "N45ogTiabclea10liscronFO<S0q5,uDeerdsoinbiDoune) cs) ean les 000173 gImoha, poesto ReyGogGriEoSemFpEeS isin BgeEnGe EE A IE ror IE 13 am oM-28 2% 200 0 0-4: AMIR 106 sees SH Sam dm-nn A mean 0 G0 ees m0 eo oe eo ae oo | Comene 1 OR Wer 08-17 14 10 22 081S0 1 ue es-is Np er A oficicaesmPl<y05,Boner (Dun) et)fr heses ofbe 0AE 000174 Table 1 3PaMpeCdoompfa1n21y Thyroid`RDeescautlutrsMbalyeQuParrotdiulcetoiofnSEemrpulmoyPeFeO(SDNi=st1e6b1u)tion* | A Que1 112.40 Quite FM i l ($V12 40) Tage TH ws 24 tok oses3 24 08 ap 02-E LE a sr 1 aewn 8s Gs 1s ome Mem 10 G0 01 0613 LL 02 oamie mus seme me mw s-be J EE TEI mm be 24 03 azn 2s 2s os deed mwwe n25oeseiTgabflcea1n3fyodrisfeerruemntP(R<OS0qu,arBtoinlfeedrirsoinbia(iDounna) es) can valu. VenQuMriellea3 04S-p41) Wome Men QuMietne 40S4204_0_)funic 24 S15 08ee 30 24 04 asnd ass 17 arms ass s1-114 ML 02 0rnis 0 or 08-13 mW au gem ns 06D 91-190 EE 26 25 0s Asus mo 19-34 : 000175 Table 15. HematoDleogcyatRuersMlaslebPy QruordoiEfmSulpelrcoueymtePe(FiNOS=o1D6in1s)tibtiont TiQSeue=3, Range Wa MQuei 2dSvb=o) TageJ n Mtn 50 Home wr ws 2 wu 6 6 2: em 6 6 1 wR Wm 1 3 09 mama Si 2 0a Ma-ma isa Se 10 mi-PS Mc a5 so o> 4005s So so 03 Aiese sa $0 IB 41-60 WBE 6 Gb am 6 se be M2 es S915 4lme des me Wo 6 meow wm ewe om mw 0 mem osiiI fnty ie snPr <0c5,uDo eifaernes bDioen) es)ms vs: aw cbormipdu es Wen QMueessi=SdOo) Reg 6 8 u 9% 12 isi of no-les $0 SO. 04 Da-sy es 13 28-ns wm 6 mow 000176 Table 16 UrinalyDseiscaRteusrulMtaslbeyPQruoadrutcitlieoonfESmeprluomyePeFO(S=NDi1s6tr1i)bution Pa3gMe dC5oomfpa1n2y1 Quarile 1 N(%) Quarile 2 N(%) Quartile 3 N (%) Albumin 13 26 13) Blood 38) 4(10) 410) Sugar 3 - 13 202) Number of Employees: Q1 = 40; Q2 = 40; Q3 = 41; Q4= 40 *See Table 13 for serum PFOS quartile distribution Quartile = N% 10) 13 0 000177 Pcaoolmi Tae 17 Clit becatorMilReeNuosnbPryoQduucatiiolnoEfmSplcouymePe(QRuNOi=SsD53i00)s8ieb1u0ton EIS : B Qeume 0o12m13swanie owPRowinoi w on_noe aw etARwTan ve om apm Le en wn Leo om en Tew or Oe ou aw awosan ow ome oe wn as owe os om on ow-in ma Me wa awn 43 J um am wa I wR ae es a me me soma a won wma am Wa a msms we me mow wr me mm we me wend s J a mow sweo ne we Ly Ve em eas 1 em oe mo oom ew ae wm ew ww wen wma oa wm mm ws wm wwe eo Ws am wm mm em a ame maw wm aw aww ae ow momo ws we TF sa ww m om mmsmWow? ha a a bw we mo ww omow mom A oe een eer 0 ant J me oor om sea wre or om ee a oe ems Ns am wo ww om ww um Fo to wear een we mow pen Woe ww uma wee 8 wo 2% -166 lucas "" 9 B 6 mete tea)from themeanofthe 1% quantile 2 cw wm 000178 Table 18 ThyrDoeicdaRteusruMlaslbeyNQouna-roPtfSirelrouEemdmpPulFoOcySeteD(iiNst=ori5nb4u)tion SeMCrompmany Ni Qviuese 4S-b13 ange MeanMeQduaine2S8O214 omge MeinQMuten3 i1SO49 Fame Mew MQeduaniSeOt) Range TH 20 08 10 osd2 21 19 13 0mos2 30 2020 Le-Ms 16 1S 09 04-36 El si on 12 oIw 8T 2 79 16 62c -107 S082 13 6-02 87 a17 2a12 7e0s--10u9 Cm momm2on mmeewm mao m on B3 Mmeamne 7 0MB3 sm elsen neom 3 9Ei-eBe Comer om oe 27 28 64 20-34 24 26 04 18-32 24 23 05 12-26 25 04 20-32 m=. +"4o5amTapbilcea11 ofr seerunmP(R<OS0g5i,Bcondfirtoi(oDnome es)mes valves . 000179 Table 19 F3aMeCsoomlpa2n1y || HematoDleocgaytRureMsaloe NboynQPuroadurctotifoSineErlmupemloPyReOeS(NDi=s5ti4b)ution* | NiiQuiaels1giS=pt) a_ng_e _"_e_anQuMalic2in=1a orgs Vien QMueems(iS=D14) Wangs Mew QMueidtaen iS=O13 Wage WT 6 a a mes 4 4 3 am a 6 3 aes 6 1 8w NOB 153 ise 12 mooie 184 150 Li W2-mE M9 Iso 08 De-167 ISO ISI 05 10-160 RBC so so 03 47-55 $6 49 2% 45-181 45 48 03 43-53 SI 51 03 46=ss WBC el $7 22 4-bi 60 61 lo 30-82 60 51 Ll 44-86 64 60 16 44-08 faPdueens 2 Ww mWw @B OmePw Tme"an WB mou6 M0 We SW 2m Hes SeegTioaDntfodsieentPRFO<S0u5,lBoenedirsiiDounne) es) cnvale 0c0150 Table 20 Decatur Male Non-Production Employee (N = 54) Urinalysis Results by Quartile of Serum PFOS Distribution* Pa3gMe Cd9oomfp1a Albumin Blood Sugar QuNar(t%il)e 1 00 205) 000) QuNar(t%il)e 2 00) 0 00) QuNarti(l%e) 3 0 205) 0) Numberof Employees: Q1 = 13; Q2=14; Q3 = 14; Q4= 13 *See Table 17 for serum PFOS quartile distribution QuNar(t%il)e 4 1 0 0 000181 | Tet rauCosmpery DeClciticulCFheemmaisPredRiecsitosn bayndQuNoani-lProodfsSceirounmEPmRpOlSoDyeiet(4t=o5n) | Fa o m a om aal mee ae an anaThl amrei umow ok men ae ei enTeaa WO eet om on emom om em om aeeam Pom wn ee sm oss Tr aa ex ew en-de wm ew on owen IWS 1B om ames wD 2m bs mm Mo% wx oma 6 8 ow ms 4 0 6 mw ww 1 ws Wms mew mss mows sn mews ms om as meme me om a meas ewes 41 wo am ww ow am ne mem wn ow aw omy3 0 5 wm 3 0 0 em + os em ns ns ew ber Bow eer ore er oie wo or weer ww a eo Cd Wm 6 mew om mu mae wm 8 wen om a mow ws wu we @ = on en ew ww ss 0 wn To wwe wm wm mw am ow wm awe a ww wm I wr wwe em wom x om on om we ow 5s ew st mow x ona wows ww ow ws ew ow ns uw ar mw on em won 0 wx om on on ea nw 6 ee mabussa 40 06 03 030s 0s 06 0 we G6 0s eee 0s 6s 0 oar wF om mo 4 sm E oowmoomo 3 ww won en on ns ow Comore 0 ot 0x een or oro oi ww oe 0 eo ow Ge mm 5 nem ww so mw ww 1 ow nw 5 mm NbrfF oesby ton gry le {Me pct lc.1%, ron Decafof ntbe ee II Cawina ioa n eonomeb5iSmW ict RiemiEtSoSk Eiteimei |ers2 | Tabe22 PCaeosmtapl | `DecaTthuyrrFoeimdaRlseuPlrosdubcytiQounaarntdiNloofen-SPerroudmucPtiRoOnSEDmipsltotyie(oNen= 48) E pote 1r 1-1 TI Quea quae3-a 1 Queicau=1y CT Tw mow noma 2 om wb wesw am 12 wes 1m es bea TW as esos 9 ww sem: sr m0 1 wens a mM 23 sew FT 10 W000 0.3L 10 e103 to 10 on wel Go 10 or asi Bom om mem mom wen me aw % dew @ 2 2 wwe mR ow 3 ww ow om 3 mw wm x 4 mw am om 4 wn mw wes was 2s 2s 0s Gea 1 2 00 lew mw 0 aes NTosigsIificay difrotF(C<S05,Bonfetroon (Dnun) et)mes vl 000183 Table23 DecaHteumratFoelmoaglyeRPersuoldtusctbioyn QuaanrdtNono-fPSroedruucmtPioRnOESmDpilsotyiebeu(tNion=48) Fie Muedtaen 1-SD1 Tmge Www 3 wes WO m6 17 12 99-4 RIC 43 43 03 Meds WC 67 63 20 42-07 Paes AC 0 6 0 Win QMueidtae20S4D-2) Wage Wen QMuedaen i5=01 Fame 0s 2 es 1 %ew D3 03 06 Ras 29 18 05 BONS 43 43 03 27-48 44 43 03 39-50 66 6S 19 43-104 59 62 17 20-84 Wm Nee WS@ WW 26 MW Wem 5iccnnTabble21y noryselrceoRnOnS.<qu5a5r.tDiBcirdriatesioD(nuuecetffebhee mmnmoffhe =gstce hiinn ccmtt fffl 7<<555.DBrroonsDDeoen)foosbeernnooffbhee3g ltele Pag0eCsozmapran2y1 Wem QMueidtae4iS=b1) Farge 0 0 4 ues NA D4 14 3-162 43 44 08 39-50 76 75 19 42-104 m3 5 9w 000184 Table 24. Decatur Female Production and Non-Production Employee (N = 48) Urinalysis Resuls by Quartile of Serum PFOS Distribution Pa2gMe CS3oomfpa1n2 Albumin Blood Sugar Quartile 1 N(%) 00 207 00) Quartile 2 N (%) 0) 00 00) Quartile 3 N(%) 207 305) 0 Quartile 4 N (%) 0 00) 00) Number of Employees: Q1 = 12; Q2= 12; Q3 = 12; Q4 = 12 *See Table 21 for serum PFOS quartile distribution 000185 Table 25 PreStof120 `Who HaNduAmbboevreofRePfaerrteinccipeanRtasn(gPeerVcaelnuteisnfPoarrcHnehpeastiisc)CSltinriactailfiCehdebmyisAtnrtywTeersptosrbDyeQcuaatrutirlEempoflSoeyreuemPopPuFlOaStiDoinsstebution san EAt coe Miia! 0 Om Om 0m Md om 0m 00 G0 Km' 00 0 00 se ase r a 10) 00 om om be 0G Sm 10 0m Gm om Se ee a e weeoaree 10) 0 0@ Sm Gm 1m 0B Sm Ge 0@ om 0m 10) 10 30 Gn 10H 30) 10 G0 0 oe cm a mati re at = dm sm) 40h sen 0 05 Om 16 ca im om en rat 10 16 20 10 Niel 0@ 0G 0B Gm Gm 10 om eB SO GR 0@ 00 0m 0m IB 10 0 0m J I bon S$c5Eh5TuTtaieklAeeidfono uePvnoFP,ROOSSAgSnaT.tiAeeLTd,GuOTii,snTo and DicBit 5$555TTTilolleee 1310aresntPPPOEOSSSpgqullaetee hbitonnn SekTe 1fo sr POSql dibaion 4h O 30 60) Sm 3G) 60 IG TD 1 Tm oh, l 300 200 1 000156 Table26 Flsorochemical ADnetmwoegrrpaapnhdicDeantdaCrlinsicalCPhreodmuicstiiroynReasnudlNtosr.byPQrouduactlionofS(eN=r4um2P1R)OSDisibuion Pcasosmspoarn1y1 fone Tos om om on oem ow ow an coco dor as an om oom la om up ower dor a eo om sam LOM Le om oN-se a Ww ox bm me a w wa mi ar mi 0 mes me Ms 40 mem owed 0 ws sm maw Coty 0 + we so wm oa F Coed We. 4 wS m me an 6 mow ww mw em 0 8 uw mm eta wm mem ws em mes ao GW mew @ ww we wr ow mw wm mm om aw wx wm 1 mes mw 6 wee wr ow mow me mm ou we Time 100 G9 0 asa os as 03 meas ww m1 am mon 4 am Comme 12 0 es ones 1 me ea FR Ge Len ax Le G0 Lp Im om @65 mW) 4S 6 eq 6 om eS omois 20% 26 10) 10mm one 20 20 10 om-nw oees a am ison ma 5 mw nase ma ue 45 mass ws wo a oe 6 0 Ww 00 ms ew wow mo a 4 mow ow & Bue a 8 mew wm mo omem msm wom @ 9 ow Wwe Ww @ was wns em 3 ww ww 7 1m mM 3 we mom ou ew ww as on on meio of 07 03 eam I CE mw samme 3 en 1 WM esse Lip 03 esis "Table26 continued) 3M Company preseotizt "Numb of maecmploQeueistbey oan, proiction egyQusnidtqea?ri (peice fn Ti NaaTRn Neon penbesis) Todi QuiNts Ps | oy = ` ene 7 = " sn ra TRG we mee hide wen 0 Poles QuiNeatePueckn 2 @ ` wes ee | iteemnnipgceftyyciffsooteaty<<0533..DDBelrstraron(D(Daua es iimthheccconnofoff e3Z1ucl'e ee py lls P< 3 eco) 8 oi co 4 re 000188 Table27 tra3pe0e4CSo7m0p0a1n2y1 | `Antwerpa"nTdhDyercoaitduRresMualtesPbryodQuucatrtiiolneaonfdSeNrounm-PPrRoOduScDiiosntErmibpultoioynee(N =421) Vics Qpiuedion SO10 ange WemMeQudianne?(4Sb=105).fame WenQMuogean 04S1O06) Fame Wem QuMiettien403SD109 Fame TS 20 19 12 e@-s3 31 20 66 03-63 (20 17 20 02-88 25 19 28 0s-2us Ed B30 BS 0124 S0o9--1n5s 8L2 Lme 0M14 4026-l240 8M3L 8L2I 0A2S 3043--l96 8L4I 812 2M02 4078--i16d Feet 11 1 n a mn see ms mm sem me a ese mm mo gm mR Ww 3 mew mB 3 ua WW om 3 we om 3 mea mm 27 27 0s 12-42 26 25 04 12-40 26 26 05 10-41 26 26 04 16-36 eS "eSteeeeemTnublee2e6ffytotrsyyedlamoriFotOtnSPP<<<di005s5,.,iBhueirttoroenronss((nDeoeee1tscfhomem ehhei memcafftBhee3=1Gqrualect'e en lcntyict < 5Rte ue 1a oh mf he * are 000159 -- acsoimpaans || Fluorochemical,ADvetmwoegrraspnhdiDceancdtClFineicaaltChPemriistoynResnuldtsNboyQuParrduiclioofnS0e4r2u9m7P)ROS Disbution Te om om omesow m ont v on ae m sl ean ow an as = mma t 80 00 n aw aa nos B mr am om oo eseT n ond on an gman owes aa onsm en anY ew ew awei Emae Elmm9 oumemms Bwewm 7 m5-m9 ds EbIe Gw2e5-5n8 w"Rosms6 w0e-2s cov #8 4 em Fo 3 ew 2 0 7. LL em # o b oa -- 0d we et a mw mem wm wom wm ow ene 0m mow ww on ea wen #0 om mm a en mew oti nm % ma ww 4 E mm ww E 9 am Ww wm awe ew me mw wr ww 1 am we wu mm 4 ma sa ws won 6 6 ww eww mw wom aw en oe ws we ww 1 ee mows wm mow 7 ow I J J ee ow ou Mew ow wn sons 8 I I LE ER non em o nn eam 00190 |1| Ta28Colntee) | "Number femal cmpolopter sbbc eccocT eransd gai (centinpea es)ues Tha outs ous 3MCompany -- . . rw . ." a: wwawe o mmfrsettstfeoe<20 t re et n 1t ofmoneeereemme t re 000191 Tule20 PaIgMeC0o0m1pa1n2y1 | Antwerpan"dThyDreociadtuRresFuelmtaslebyPrQoudaurcttiileonofanSderNounm-PPFroOdSucDtiisotnriEbmutpiloonye*e (N =97) | Que|. - "WomWaloQnuatS2eb ange Wen WQotaun e$0 Romy SH a1 22 12 ameas 22 20 1s OMe 35 2 cl 07-65 E wr 02 20 sens 98 98 3 46-3 99 93 23 SEs OE I n Ws a0 wm sem a ms CT meds mS sem me 4 we 3 om 6 mew mw wm 3 pox m rmow a w15 0w s aw io 2 30 28 3 A7-a4 27 11 05 1 | +eNoSseiegTnaibfliec2a8nftoyrdsifefreuremntPF(PO<S 05, Bonferroni (Dunn) quartiledistibution test) mean values Wem VeQduainteS4D. Msg 23 22 10 10oS2 91 B12 Si 01-12 mmm we womo4wem a a 0 M30 i 000192 en Fi | Wh 1 Above ReteRaamtb VtPtcBioppns (CcheteiCPenetns)byEbmypQluan FpoifSlestinPROSDihtion son _-- a F ; a eaw e ee Mak Boyes event --r--n ow wn om tm 10 om wm ' . wm ke om om ow mw 1m ew mw E rae-- R C -- T e ------ J 000193 Tae 31 | | Mul{otrivAarmniadeblrOe lRneegdrDePsaosttieounntMMoEdoxelpleloaEnfamCtpholorolyyesVetaeerirPaoablil*ceibspyanPtFsO,S So Metical Surveiance Program eee Inereept pros Production Job(yess) AntwerpDecatur ee a Clgaeesdny Drinklday Years Worked ROTO som [2 -o010 ~0s 0006 oon 00007 00s 000 sec oust oon oom os oo oo oon oor2 oon pwwe 001 o " a an " ao 15 | R=08 ! A"GNRu=a0l6og racCiooptya pwi > <ot <on <a o <ot <n o <a 000194 Table 32 MulivariasnbdlOetRheegrrePostseinotniaMloEdxepllaonfCahtoorlyesVtareirsobllebsy PFOA forAntwer"2p0a00ndMedDieccaatluSruMravelielElamnpcleoPyreoegPraarmticipants, | woo Parameter se pualue Inereept 5069 0080 001 | PFOA 001s 0008 0 Production Jb (yes/no) 0012 0024 Le Aniwer/Decatur -0032 002s 2 Age 0007 0002 001 BMI 0001 0002 " Cigaretesiday 00006 0001 2 Drinksiday | Ves Worked 003 oot oom oon 005 a .- A"NatRura=l.l0o6g P3aMsaC3oomlpa1n2y1 Partial R <0 <0 <0 0 <0 <0 2 <n 000195. y Table 33 MuliviblenRgoresisonPoMtoednetl oEfxChpollnessotreyroVlarbiyabPlFesOS and PFOA {oe Amer53y00ndMDeteicntSMuolelEampiPyroegPaamricpans, Pwr SE palue. nent S066 ost <n pros ois 000 1 Pro ous ooo P Protation 0 ese) ons oo " AniwepDccae om ons ae 07 ou 01 a oot ao o -- oor oor Py Drnktay oms oor2 aot Yours Worked oom oor is Ara-- Paral R? . <a <a <a <a os <n <a o ot Nag R=08 ] AdjR'= 06 000196 F5aMeCSomapraanty | Table 34 Maliva"rainadlOethReergrPeostesnitoinalMoExdpellaonfatCohroylVsatrriaobllebsyTOF for An3t00sw0nMdeeDdeicrcaatlpuSruMravleielElmanpcleoryoegerPaamrticipants, Parameter s8 Inecept 5065 00st || Tor oois 0006 Production Job (esio) -0018 + oon AntwerDecaiur -0034 00s Are. 0007 [3 BMI 0001 oon Cigreticsiday 00006 * oot Drinks 00 oon Years Worked. -o00 oo owe? | RAG0RI8=07 "Naural log | pia Pari B <o001 . <ot as <0 as <ot oot os @ <o El <or 0s o 6 <0 000197 m-- Me ome, RAlG=R3I3=32 ms PR o m m Se w m wma.nn o a;. Parameter SE value Partial R* 000198 Tie36 foMrolAinnvaderarOblaeendRePDgercteastseuironMEMaxoipdaeEnlmspooflroIyyDVeaeLriPaabbryliPecsFpaOnAs, 2000 Medical Suilnce Progam eeeemer eee VOR Inert as | Proa ~oo1 Production Job(yesno) os AntwerpDecaur -00 ae oo Ba ~o019 Cigartestiay ~0004 Drinksldsy oom Years Worked -0001 se pele 00% <n 0009 o 002 El oos 5 0002 oon <oon oon aos oom <0 oon 4 FSaMeaCromaptaanty pei on <or <0 o on % <or | R'=34 A"dNjaRura=l o3g2 : 000199 _ Inereept PROS PFOA Production Job (yesino) Anmwerpecatur TM BMI Cigaretestday Drinklday Years Worked eRA=G3R4= 2 "Natural log Table 37 MulivarisbalnedRheegrressPiooennMtoaldeElxoplfaHnDatLorybVyarPiFabOlSesand PFOA for Antwe2r0p0a0nMdeDdeiccaatluSruMrvaeliellEamnpcleoPyreoegrPaarmticipants, Parameter se. pulse aan 00% <0001 0006 oor2 -000 0010 o 002s oan 36 003 0028 EY 0001 002 50 -0019 0003 <0 -0004 0001 0004 oon ooi4 <.0001 -0001 0002 49 P3etCaomrpa3n1y Paral B o 0 <ot " <0 on o 0% <0 000200 nreent Tor Production Job(yesne) AntwerpDecaur Ae Bt Cigaretesiday Drinksldny Yeas Worked om Wa A"Nat=al l1o)g Table 38 MaliavnadrOitslheeRPeogtrenetsisailonExMpoldaenaltoofryHVDarLibbiyeTs OF for Antwe0rp0snMdedDieccaatluSruMrvoeliellEamnpceloPyreoegPaamrticipants, [rr se pualue wm 00% <0 -0010 0007 u [2 oon " -00s0 os os oon ooo #5 009 0003 <o00n -000 ooo 0004 0084 oon <0 ~00009 0002 58 Fadel it Paral B 0 <ot 15 <0 o o 0 <or 000201 Inercept PROS. Production Job (yes/no) AnwerpDecatur Age Mi Cigaretelday Denkslday Years Worked wot? RAg=G2R8= 21 "Natur log Table 39 MulivarainahdeOtRheegrrePsostieonntiMalodEexplloafnaTtroirgylyVcaerriisdbelsesby PROS for Antwe2r0p0a0nMdeDedciactauSruMrvaeiclElmanpcleoPyreoegPraartmicipants, Parameter Se pale 2768 02 <0001 0066 0026 o oo 006s n ost 0068 oor 000s 09 005s 0007 <0001 0008 0003 0 oom 0034 -0007 0004 0 : 3PaMgeC1o0m0p1a1n2y1 Panis) 0 <0 a0 10 2 <0 <0 000202 Inereept POA Praducion Job (yesoe) AntverDecsur Age war Cipueesiny Drinkaldey Years Worked Je RA=R2= 21 "Natl fog Table 0 MolivasiaubndleOtRehgerrePsostieonntiMaoldEexlpolafnTatroirlyycVearrdieasl*esbyPFOA for Antwe2rp0anMdeDdeicctauSruMealielEamnpcloPyreoegaPmar.ticipants, pum ise pie 270 om <o001 0066 oo wo ~0004 0066 55 om oon oon 000s os 005s 0007 <o00t 000 oon ons oo oom 1s 0007 0004 a enmopn Paria 05 <or os o 0 <or ws 00203 Intercept PROS. PFOA Production Job (yes/no) AntwerDecatur Are MI Cigartcsay. Drnkslday Years Worked ee... RAG=E = 21 *Nauwnl log Table 1 `Mulivarisble RaengdrehsesironPMootednetliolfETxrpillayncateorrdyeVsaribayblPeFsOS and PFOA for Antwe"r2p00u0nMdeDdeiccaatluSruMrvleiellEanmcpeloPyreoegrPaamrticipants, tamer SE pualue 2m 04 <.0001 0037 oom 2 0053 oo 2 -0021 0067 26 0109 oom0 n oot 000s 01 008s 0007 <o001 0008 0003 0 0030 oom as -0007 ooo 0 PuetrCoomtpa2n1y Paria R* 0 o <0 0 " a0 o <0 <0 00020% . Inert Tor Production Job yes) AwenDecaor ne BML Ciguetestiny Drinkldsy Years Worked owloded Ag=R2=21 "Nawal log Table 2 Ma{loirvAanrutnswdebOrlntReserngdrPeDosteescniatotinaulMroMEdxleplelaoEnfamTtporrlyioVgyayPseaeircsiibpdyaenTssO,*F 2000 Medical Survilnce Program Parameter se phe 2736 om <o00t 00% oon? 009 -oor 0067 & ous oon 10 oon 000s ws 005s oon <o001 0008 000 wo oon oom x -0007 0004 o ~~ a swcom Pus R* <ot os o 10 o <ot <ot 000205 | a [I Pros Produion Job yes) AntwepDecsuc he a Cipretestiny Dik Yours Worked Cec Tiet nes | AG =16 "Haunt log "Table 43 liv{oie AanReegrnrsarindotnDeeeicltlMsoflpAellaEinnrpeyPoVhaoPsrrpathihaitaensb,y FOS 50 Met Survie Pog Parameter SE pvalue sms os <r 0013 oon 2 ome oon 2 ou oo <a aos ou ES "oot oot 2 om oat 0 "oo oote 1 "002 oo a oon oo 0s aeons .Partial R" <a n pr <n <a <a <a 000206 Table44 MalivasisbeaRnedgOrtehsesiroPnotMeontdieall oEfxpAllanaaitonryPVhaorsipahbaletsase byPFOA for Antwe2r0p0a0nMdeDdeiccaatuSrurMvaeilllEamnpceloPyreoegrPaamticpanis, Pane SB pale Inereeps ant ozs <oo01 ProA 0001 0010 Production ob(yesno) 0047 oo Las AniwerpDecatur 01st [= <o001 | Ae 00s ou 0 BMI -00m 0004 2 Cigaretesiday [ 0001 as Drinksday 002s [2 a Years Worked -0001 oo EY Tighyerdest [ oo 000s Rests "ANGawIal= lo1g0 FMsCToSmopla2n1y Puri 0 <0 10 <a <or <0 <0 <or 000207 Inercept PROS PFOA Production ob (yesho) AnwerpDecator 3 MI Cigaretesiday Drnkslday Years Worked Trglyeridess -_ RAG1R8=.16 *Nawnl log Table 45 Mulivarisble RegrensdsiOotnhMerodPeoltenotfiaAllkBaxlpilneanPthoorsyphVtaarisaeb*lebsy PROS and PFOA for Antwe2r0p0a0nMdeDdeiccaatuSruMrvaeliellEamnpcleoPyreoegrPaarmticipants, [a SE pale a4 0128 <1 ots [x 2 -0005 oor2 85 000 [= 2 0153 oon <1 00007 0002 a -0004 ont 25 0002 ooo an 004 oor? as -0002 0002 "2 008s oot os . P3eMtCaomlpainny Paria B* " 0 <0 <0 10 <0 <0 <0 <0 <0 000208 Table 46 Mulivarisbl"enRdegOrerssiPoonteMnotdieallEoxfplAalnkaaltionreyPVhaorsipahblaetsase? by TOF for Antwe"r2p00a0nMdeDdeiccaatluSruMrvaeliellEamnpceloPyreoegrPaamrticipants, P5eM Caomtpany AlkPhos _ Parameter se pulse [NN Intercept am 0128 <0001 - Tor 0006 0008 La 0 Production Job (yesho) 0037 oom 2 <0 AmwerpDecatur 0147 oon <0001 a0 Are 00008 ooo n <0 BMI -0004 0004 25 <0 Cigaretesiay 0002 oor a8 <0 Drinksday -0024 0016 I <0 Years Worked -0002 oo as <0 Triglyeerides [x [ 0006. 2 0 RAG=RI18= 16 Natural log 000209 || ]]] ] Co em ros ] riguo J-- p- Cm --" Coa en Toon Mian Ri=25 AdjR'=23 Tew r opeoree eseonof, GeTenbyFOS - Pumeler oSEn _ pcuaolume oon oom -0m2 ons * os oss ons ont <om 5 one ows or ons x om or oi oo own " om ons coon us--e_r-- P .anial B " w o a " = on = 000210 | Table 48 MulivaanrdisObtlheerRePogtreenstsiiaolnEMxopldaenlatoofrGyGVTar*iabbylePsFOA for Antwe2r0p0a0nMdeDdeiccaatuSrurMvaelielElmanpcleoPyreoegrPaarmticipants, | _ Parameter Intercept L245 PFOA 0032 | Production ob(yes) -000 AnwerpDecatur os Age 00009 BMI 0006 Cigaetesday 0003 Drinksday 0116 Years Worked 0003 Trglycerides 0289 -_ | RA==25 21 Natu log. se 0238 oot 0060 0065 0004 or 0003 oon 0004 004s pualoe <0001 010 Ca 0003 #" as 28 0002 40 <1 P5MeCoomrpianay Paria RY . o <0 0 o 2 or 0 <0 0 000211 Table 49 MulivaisbalnedROetheesiPootnentMioadleElxpolfaGnaGtoTrybVyaiPsFbOlSesand PFOA forAnte300n0dMeDdieacltSuMrvleeillEamnpcleoPyreosgrPaamricipats, PaweCsomop _ Paameter SE palue Panial R Intercept 1206 oz <oon . pros oon oo - Pron oo oo x o Production ob yesho) -0026 0062 a <o01 | AnwerDecatur on 006s ES " a 00009 00s on EY 0006 0007 3 @ Cigseesiny 000 0003 zn o Dinky ous oon on on | Years Worked 0003 0004 45 <on Tilyeridest 0288 001s <o001 os -- | R= 25 A"NiatuRra=l 2lo3g 000212 Table 0 MlivanadriOathleerRPoteentgialrExeMpoldsaenalstooifryGoVGaTnr*ibsiyeTsOF. for Antwe2rp00snMdeDdeiccatlurSuMrvaeiillEamnpceloPyreoegrPaamrticipants, _ rumor se pualie nereet 1266 os <n Tor 009 ooi6 06 Praducion Job (ese) 00s 061 4 Antwerp Decatur 0235 0064 003 I [I 0004 = Bt 0006 0007 Cigartesday 0003 000s = Drinklday outs ost 002 ears Worked 0003 [x " Tighyeerdest oss 00s <o001 | Kags : MI: 31 Natur log PMaesCiuopla3r1y Parial B on <or o o o 0 <ot o 000213 | Table 51 MalainvdarOtahbelrRPeogtreenstsiailonExMplanoatoofrAydSVTaribeabylePslROS for Antwe2r0p00snMdeDdeiccaatluSruMvalielEncleoPryogPaamicipats, ; Parameter se prac Intercept ams om <oo0t pros 003 0013 3 Production Job ese) -o0n oom Lo AvtwerpDecsur ou 003s on ae 0003 0002 EY Bi [3 000 Ee) [r-- -0003 oo o Drinalday o0s2 0017 0 Years Worked ~o004 0002 05 Tglycerdes 00s oms o ,-- RAGeREg= 07 "Naural og rMeCsamopu3ln0y [ST <or <or os <n <or <0 on o 000214 ( ER epiyn `Table52 Parameter SE pvalue ievennsi awar0 wnoe -- "oe pwon ppoo" x- rSonn ownn -an -. rJe oome ouae - eSMeta sm PartiaRl wno =ww hs". 000215 | _-- | MallifovraArniistbnwlederORpteahgenrredPsosDtieeocnnattiMauolrdMeElxapollfAaEnSamTtpo*rlyobVyyarPiPFaarbOtiSiecsinpadntPs,FOA. 2000 Medical Sureilance rogram | -- ee emer SB puke erent ams om <oo0t | pros 0006 00s @ | PrroA------ 200313 aooor 2; | Antwerp/Decatur 0104 "oo 004 | Age 0.003 0.002 23 Bi 0002 0004 0 Cigaretestiay -0003 oot o Drinkslday 0052 oon? ons Years Worked -000s oon o | geste oos2 ams o UARe= 07 . Heal log r3eMsCoomrpta Paia . <n w<ot 2 <o1 <or <or o o <a 000216 | Table 34 MultainvadrOitabhleer PRoetgernetsisailoEnxMplaonatodofryAeSVaTlr*isbbiyeTsOF for An20t0a0nMwdeDdeicecaatlurSruMravpeliellEamnpceloPyreoegrPaarmticipants, Intercept TOF Production ob (yes/no) AntwerpDecatur Age BM Cigaretteslday Drnkslday Years Warked Triglycerides bummer ams oon 0031 0106 [3 0002 -0003 0052 0004 003 SE puilue om <.0001 0009 a1 0034 EY 0036 0 002 2% 0004 st [ 0 oor7 0 0002 of 00s 0 RAG=R= 07 "Naural log : Paagne C8o5mopfa1n2y1 Panial R* o <or 2 <0 <r <0 2 on <0 000217 Table 55 MuliavnadriObtlheerRPeogtreenstsiailonExMpoldaenlstoofryALVaTr*iabbylePsROS for Antwe"r2p00a0nMdeDdeiccaaltuSrurMveaillEamnpceloPyreosgrPaamrticipants, Paa0 Cgoamerpa1n2y1 S-- | Inercept Pumeer SE 144 oles | pros oo ooig Production ob(yesio) oor? 0 AntwerpDecatur om 002 Age 0002 0003 BMI 002s 004 Cigareteslday -0007 0002 Drnkslday 0006 0024 Years Worked -000 0002 Trglyeridest 0189 oon AR=I2= 25 "Natral log. puke Paiul' <.0001 - 2 on <0 <0001 % 0 <0 <.0001 5 0003 ol 2 <0 10 <n <0001 05 : 000218 | rcornept ssi amv a Comtr ros onR a oSl AVa mew poe o16s1 Iost r-e 00m won a ans am wa oon <a u on ann won oun om an arimor me w.o on a wo. Yom SR am oro on oz <a wo cS ] Adj R= 25 000219 { aes? Mlle"nd ROepgerrePsoonntMoadeElxopflAaLntTsbVyaPrRaOlSs1nd PFOA for AcS000ndMeDdieacltSMuilemEimigrgaPmrins, _ J Pros Pron Puomeer = pale 191 os <n oot ois 2 oom om Cas pa an oon cm Production Job (yes/no) 0013 0043 76 Anwerpecaue ors oo <oo0n hee om ow PF wa ons oot <omt Cipeeesiny "0001 oo oon Drnstny ome oo 5 Years Worked Er om a i R= 5 Nios Paestaatl Paral . on <a <.01 o <a <a <or <a 000220 Tale 58 Maliavnadritslblee RPeotgernetsisailoBnpMloadnetloorfyAVLaTr*ibbiyeTsOR for Antwe2r0p0n0dMeDdeiccaatluSrurMvaeiellEamnpceloPyreoegrPaamints, eswsCurps vwwmeer se pate Paria Inereen 1965 0193 <o001 - Tor om 0013 os Production Job(yesh) ~00s4 0050 Ed <or AntweDecaur 0296 00st <0 5 I -0003 0004 38 <on wr oon 000s @ o Cipmnesiny -000 0002 ons o Drinkslday oo oas @ <ot Yeas Worked -0002 000 " <or | a Tgleeridest 01% oot <o001 os | AR"Naw G=RE3= 31 : ns : 000221 Table $9 Malivarinbdl tRheeesPiootnenMotdeElxpolfaTnottoarlyBVialriiraubbliens byPFOS for Antwe5r0p0s0nMdeDdeicaaltuSruMravetielaEnmcpeloryoegerPaamricipants, PMssCoamspatyt _Panmewr SE pvalue Partial R | Intercept 0209 0.145 <.0001 - pros ~oon7 oots as Production ob(yesno) ~o006s 00% Lo. o AnverpDecatur "022 00% <oo01 1 I oon 0003 58 <n En -o0s 000s a <on Cigaetesiny -000s 0002 <1 Drinkslday oas 00 <or Years Worked 0002 oon <or | Trgyeerids ~oo1s oo 51 <r -- R'=29 A"dNgiaRn'=l2o1g 000222 | CE ie peo`MTablfe60Ta Bi HOA Parameter SE pave ParaBl enon Ls ASxge .oo-0o002 mo0=0o03 mo43oLo<0 oom kisR'=29 AiR =2 000223 Inercept PROS. Proa Production Job(yes) AnmwerpDecator Age BMI Cigaretesiay Drinkslday Years Worked Trglyerides RA=GR = 21 Nawal log Table 61 `Mulivarible R`eagnrdeOstshieorn PMootdenetliaolfTEoxtpallanBatioiruybiVanriabbylePsFOS and PFOA for Antwe"r2p00a0nMdeDdeiccaajluSruMravleillEamnpceloPyreoegrPaarmticipants, Parmer se pyalue 0209 014 <o001 -0018 0016 zn 0002 oor3 36 -0070 0037 6 0264 0039 <0001 oom 0003 5 -0005 0004 2 -0008 0002 <0001 0005 0002 a 00002 0002 95 -0016 00 36 P3aMgCeomrpainaly Pani B o o 16 <0 <0 % <0 <0 <0 000224 -- Intercept TOF Production Job (yes/no) AntwerpDecsiur Age BMI Cigaretes/day Drinks/day Years Worked. Triglycerides RAG=R2I9= 27 Noto log. Table 62 Multivari`aabnldeOtRehgerresPostieonntiMaoldEexlpolafnaTtotoary BVialriiaubbliensbyTOF for Anuwe2r0p00anMdeDdeiccaatluSruMrvaeliellEamnpceloPyreoegrPaarmticipants, Pum SE palue 0210 0.144 <.0001 -oo11 0009 2s -0064 0037 0 -0257 0039 <.0001 0001 0.003 62 -0005 0004 19 -0008 0002 <.0001 0005 0019 TM 0.00007 0002 98 -0014 00x ) PaaMgCeo3mopfa1n2y1 Partial B 06 o 16 <o <0 % <o1 <o1 <0 000225 Co erent Pros Production JobGeshe) AnwerDecaar I a [er---- Driksiy Years Worked Tigers to aAdRyI= 05 Nowra iog Tale . MulinvadritbhlerRPeogtreenstsiailonBxMpoldaesltoofrTySVHariabhycPsROS for AntwSeronnddDicatrSMuvaeeiaEnmcpeloPyreoegPaamr.icipans, vewee SE pike 0s om 1 oois oom ss oi * oon 1 oi 0086 000s 00s x ~000s oo 56 000s oon an 00s oon nn ~0008 000s 5 0204 0061 on Peter Pari . <a <0 @ <a <a <a <on <0 000226 -- Pron Producion ob yesho) AnwerpDecatur Awe wat Cigeestay Dik Years Worked Tigleerdest Table64 MoliavnadriObtlhceRPeogteenstiiaolnEMxpoldaesltoofrTy IVa*isbblyePsFOA forAntwe3r0p0s0nMdeDdeicaaltuSruMarlveeEmipllloyraeonegrPcaaremicipants, var SE "0s om oo 0027 0100 0083 om 008s 000 0006 -o0s 0009 ~000s 0003 00s6 0002 -0008 000s 0201 0002 pale 10 5 = os 5 56 0 8 an oon Ri=07 A"dNiaRwa'l= l0o5g MCompany PR n <or <o1 <or <on <0 <or <0 000227 | ae | Table 65 | Mol{iovr aAan"btunewd rOReatgenrsedsPsDiooencMtaodteElxepolfEaTnmaSptHoirpyebVyaPrPFaiOreSiscsinpdnPs,FOA | 300 Metin Survie Program net Parameter ~0s3 pros oon Pron ois [-- ome AmyerpDecauc om ae oes mat 0005 Cipretesiy 0005 Dinky ooss Yours Worked 0008 Tigheridest ammo eomee SE om om om 00s oom oms om 000s oon ous een oos Ria a fchoerid : 10 pvalue .Partial R? ss <a a <a a <a os po = <a sn <a Fa <a a <a wn <0 0----iemeeet 000228 Table66 MultainvadrOitabhleer RPeotgernetsisailoEnxMploadnealtoofryTSVaHriabbyleTs OF for Antwe2r0p0a0nMdeDdeiccaatluSrurMvaeliellEamnpceloPyreoegrPaarmticipants, | Parameter se palue. Intercept 0539 037 10 Tor 001s 0021 o Production Job (yes/no) 0097 0.084 2s AntwerpDecatur an 0088 05 Age 0006 0.006 Ed BMI -0005 0.009 51 Cigaretiesday 0005 + 0003 n Drinks/day 0056 00s a8 Years Worked -0008 0005 a2 Triglycerides 0201 0062 01 R=01 AGR'= 05 *Natural log. Pa3gMe9C7o0m1pa1n2y1 Partial R? 2 <o o <o <o <0 <0 <0 2 000229 | PaaMsCtoempra2n1y Table 67 Mul"iavndarOibtle RPoetgernetsisalioEnxpMloadnealtoorfyTV4a*ribayblPeRsOS for Antwe"r2p00a0nMdeDdeiccaatluSruMrvaeliellEamnpceloPyreoegrPaamrticipants, _ Pwmeer SE pane Pais] Inercept Pros 2263 00% <n - -0003 0009 7 <0 Production Jb (yes/no) -000 oom on <0 pr -- oon 0024 ot <0 Ase 000 000 0 <0 BMI 0001 0003 % <0 Cigaretesilay 00009 00009 = <0 Drnkslday 0024 oor2 0 <n Years Worked oor 0001 3s <0 a -- Trglyeer-- ides--ema-- ete r-- e --- o018 ----oo-- r? ----2---- ene-- <e 0 -- -- ARG=R = 01 3 *Natun log 000230 | Table 68 MaliavnadrOitbhleer PReogernetsisailoEnxMploadnealtoofrTy4V*arbiyblPesFOA for Antwe"r2p00a0nMdeDdeicaaltuSrurMvaeilllEamnpceloPyreoegrPaamrticipants, Parameter se pale Intercept 2263 0050 <o001 Pro" 00003 0007 9 | Production ob (yesino) -0005 oon AnverpfDecatur oot0 0024 Age 000 oa 9 BM oot "oo " Cigaretesiday oor 00009 2 Drinkslday 002 oot 0 Years Worked oor 0001 3 Tighycerides -0019 oor? 2 RAR== 01 "Naural log Pt Partial <0 <on <0 <0 <0 <0 <0 <0 <0 000231 eens Pros Pron Produ Ib Ges) AtwepDecar ne ot Cipmetedtay Dinky Yours Worked Trglyeeridess rR =L.i Nios aes Mui(ovraAranieiORneagnsrdePDseictoanteMroMxidplelofnBTop4rl*aybyeVePaRPOaaSlrsidaP,FOA pi Parameter SE p.value. 20 amo <a "om oon Eh oor oes 16 000s om - oot oo " oan om oor TM os ous 00009 Er oon o oor oor 1 -o0i8 oor 2 racotmipoan Partial R* pr pr pr pr or cor <a pr <a <n 000232 Intercept Tor Production ob (yesnc) Anverpecatur Me BME Cignretestday Drinksday Years Worked Trighycerdes RAG=R=03<.00 "Natural log Table 70 MualnidvOartihbelrePRoetegnrteisasliEoxnpMloandaetloroyfTV4ar*ibayblTesOF. for Amwe2r0p00anMdDeediccaatluSruMnavlilaEnmcpeloPyreoegrPaarmticipants, emer se vale 2260 0090 <0 [re 0006 Ed -0005 0023 2 0010 [ -0003 0002 0 0001 [3 o 0001 00009 a 002 Poon ot 0001 [TX = 0010 oon 8 Pug3s 1C01on0p1e2n1y Paral R* . <0 <0 <0 <0 <ot <0 <or <0 <ot 000233 -- Inereept pros Production Job (peso) AntwerpDecator Ase BMI Ciguretesday Drinkslday Years Worked Trighyeerides RA0R6= 04 "Natural log abl7e1 `MulivaanridsObtlheReergProteesnstiioanlMEoxdplealnoaftoFrryeeVaTr4iabblyesPFOS for Antwe2r0p0a0nMdeDdeiccaatuSruMrvaeliellEamnpceloPyreoegrPaamrticipants, Pam 0299 -0004 -00% 0021 -0003 -0003 -00009 0006 0002 0003 SE patie 0076 <0 [3 0019 n 0020 2 ooo 8 [2 a 00008 Ed 0010 Ej 0001 2 oo 8 Pag5eMiC0o2m1pa1n2y1 Paral B <0 <ot o <0 <0 <0 <ot <0 000234 3 Te? Muliv"andblOetrRegeresnsieon MEoxdpellaosfFtrsysVTari*albeysPFOA for AntwSe0r0n0deDelctSuMavlilEacmsplroogyrPamarga, Co ewes puke nee om ous oon Pron 0006 006 a Producion ob eso) 002s oor 1 AnverDecatc 017 tom a A 000 ool ot 00m om 2 Cipretesty ~00009 aco 2 Dinky omg ooo 5 : Year Worked om oar Tigres 0001 oot WAegre init [reer Pani . a <0 @ on <a <on <a <n <a 000235 Pa3sMtCoormpeainnys Tens || MulivfaoirsAbnlatenwdeRreOgprseensdsiPDoeencnMaotiudlrelMEoxafpelFarEnemaptToldroyyeVbasyrPiPaabFilOcesSpaatds,PFOA 2000 Medical Suveilanc Program. | - 09 pros ~00005 | POA "0006 Production Job(yes/no) 0025 AntwerpDecatur -000 Ase -0003 Mr -000 Ciguretesday 00009 Drinks/day 0.006 Years Worked oon Trgycerides oon Ria, a Noes om 000s oon 0020 0210 oon 0002 00mg 0010 oon oo 1 : on - Es <ot = <0 21 <01 " @ o E <or 2 on 4 <1 | FE) <ot mn <or 000236 Inept Tor. Productiloonb (yes) re i er Drinksday YearsWorked Trigleerdes AR=R06 "Naural og Table 4 MalivaanrdiOatlheerRePgorteesnstiiaolnEMxopdlealnotfoFryrVeaTr4isbbeysTOF for Antwe2r0p00ndMeDdeiccaatluSruMravleiellEamnpceloPyreosgrParmicipants, Parameter se pualie 0299 0076 001 -0004 [es 2 -oms 000 a9 -0003 0001 -0003 000 a3 00009 00008 zn 0006 0010 Lo oo0z 000 1 0004 [ a : Pu5sM0C5on0pa1a31y Paral . on <ot on <on <oi <ot <on <0 000237 _ een ros Production Job he) AnverDecaur I oa Cpmesiay Dinksday Years Worked Tigers RAR-Es 34 "Nand Tables MulivaanrdiOatlheerRePgrecssiionEMxopdlealnaotforTyHVEaRribeysPFOS for AneSr00n0dMeDteicsaal iSuMrvaeliellEanmcpelProoygrPaamicipans, Parmeter se puae 3589 00 <oont 0003 oon " 0006 000 5s ~00 oon <0 ~0o00s ooms PF ~o001 oor ~00007 oot 5 001s 00s os ~o0m2 00007 mn 0003 oo 5 Page106.f 121 ' pani <a 0 <a <a <on a <a <a 000238 Inereept PrOA Production Job (yes) AntwerDecatur Age Mt Cigarettstday Drinkslay Years Worked Trighyeerides RAGaRs=M "Nur log Tale 76 Multiv`anrdiaObtlheeRrePgorteesnstiioaln EMxopdlealnaotfToryHVaRriabblyesPFOA for Antwe"r2p00a0nMdDedeiccaatluSruMnavlcilElmncpeloPyreoegrPaamtiipants, Parameter se pile 2589 oon <.001 -0003 [re # ~0006 0010 EY -008 oon <.0001 -00005 00008 a8 -0001 001 2 -00007 , 00004 13 oats 000s 004 -0002 00006 an -0on 008 6 PaMs 0C7o0mp1a2n1y Paral B* 0 <on <ot <on <0 o <or <0 000239 st8 0FON REE a wv s ow Paonomenter sonees po"palue | nor es on aan a" ] oJ nAge oio0.0006. aor0.0008 a"a Rrait onns ije RAiG=R3I5= 34 . - cee : 0Partial wn <0! w. wn Table 78 MuliavnardiOstbhleerRePogtreenstsiiaolnExMpoldaenlatoofTryHVaBriRablbeysTOF for Antwe"r2p00a0nMdeDdeicactauSrurMvaeliellEamnpceloPyreoegrPaamrticipants, Parameter se pualue Inercept asso oo <0001 TOF -0003 0003 2 Production ob (yesino) -0004 oon a) AnwerpDecatur -o0s8 oon <.0001 | Ase -00006 00008 as BMI -0001 0001 a8 Cigaretesiday -00007 00004 3 Dinkslday oots 0005 004 Years Worked -00002 00007 mn Trglyerides -0002 0008 0 RA=GR3=5 34 Natural log Pu3MC1o09m0p0a1n21y Panial 3 05 <0 2 <0 <0 <0 or <0 <0 000241 Table? MalainvdriOtbhleer RPeogternetsisailoEnxMploaneatoorfyFTVaIr*ibayblPesFOS ] for Antwe"r2p00s0nMdeDdeiccaatluSrurMvaeilllEamnpceloPyreoegrPaamrticipants, | ee vumee SE pase Inereept 129 008s <o001 pros -0006 0009 as Production Job (yesh) 0009 oo os Anwerpecaur 007 002 0004 | he ous oo o Bt -00001 oo0z 9% Ciguretestday [ 00009 82 ] Drinkslday -0008 oon " Years Warked oor oor a lly! [I nnn In em : A "Naturw al log Partial &* . o <ot o @ <ot <ot <or <n 0 000242 : ew R..iirevd | Molise Regrsion od of TibyPOA | (ocAgnanDecctsMaotoEnlroeen FaiPnatipnt,s, en \ Parameter oSoEn. won wom oom Pobeionkbhe) 0012 |J J oon - om oon | wn oto oon os o cnom .on pvalue Partial R* on Dry Cigareties/day om0.0002 aon0.0009 "80 on<01 Yon Woes om oon . Py i -- wom oo 1s wo fri R'=.10 Adj R= 08 000243 || nen y Mu IEpre ie WAre ltivariable Regression Model of FTI* by PFOS and PFOA ee ee paow asaess p<unne mos a om o ron aor os | | potion) -o00 om - mens oom om wo fot os on wa ogo on " pees oro gos o pina ooo - " Voor oon wi " Ti oom ons n R'=.10 AdiR'= 08 *Natural log. wiz Part}ial B " wn wo " o wo I" m or 000244 Table 82 MuulinvdarOibsebrl PRegtresesioEnxpMloadnesltoorfFy TVIai*sblyeTs OR forAnwe2r0anMdeDdeiccaatluSruMrvaeeillEamnpceloPyreoegPaamrticipants, | _ emer SE pane ree 129 008s <oo01 Tor 0003 0006 a Production ob ese) -o0i0 oon AntweDecatur ~007 oo on I -0003 3 oon 0 1 ~00001 oon 1 Cigaretestay [ 00009 5 Drinksisy 0008 oon " Years Warked oot oon " geod oon 0016 6 wAG=R1I0= 08 . Non log rCaosmpar Paria N on <ot 0 @ <n <0 <or <n <0 000245 Table 3 forMAunlitinwvedarrOpstsbhlenrdPRDoetegecrnatetisuasrliEoMnxlMepodlEemalplonfoyVTsea3tsr#iPoabahyrreiPyscFipOnSts, 2000 Medical Surveillance Program ee pewmeer [-- am SEC . oon puke <.o001 pros oo1s oon o Production Job yesho) [a oo AnwerpDecatur 009 oo <oo0 ee -0002 0001 2 Bl 00s oon Cigartestiny 0003 00008 wo Drinksday 002 0009 os YearsWorked -00006 0001 Tglyerides 0020 oon as RMi=.R1=2 10 Natural log Fae0iCoor p5y) PwidR . o o 0 <ot o <or <ot 000246 1 || Table 84 `Mul"iavnadrOitahbeler RPoetgernetsisailoEnxpMloadnesltoofrTy3Va*rbiyablPeFsOA for Antwe"r2p00a0nMdeDdeiccaatluSruMrvaeliellEamnpceloPyreoegrPaarmticipants, Paes SE pualoe Inercept 4 , oom <0001 Poa 0016 0006 o Production 1b (esha) ois 0019 a AnmwerpDecatur -0109 00 <.0001 Ase -0001 0001 = BMI 000s oom o Cigaretesday. 0003 00008 oo Drinksday 008 000 0 Years Worked 00001 001 0 Trglyeridess oois , oou 2 RAGEag=. "Natural log Pa3MgCeomlpa1n2y1 Paria B 0 <0 0 <0 0 o o <0 <0 000247 ---- ess | OeMPeadachlaopsyFoVgrrons for Antwerp and Decatur Male Employee Participants, --_-- eePaeter SE pwle J. an oom <oon wos ao TM wou oon oo Ce Production ob Ges) oon aon Avene "009 ono <oon TM "aon I 5 a 00s a2 on Cipreestny 000s aos 1 Dray "os oo on Years Worked ooo aon iors oon oon 2 = 13 Ntiog rar eotts PamiaR . o <a <a <a @ <a <a 000248 . Ties MoidlOvvear PReogrrescsioxnpMlondeolnoyfTV3#ibysTOF fo Ama0ndMeDdieacltSMutmEimopgrPaips, Parameter SE p value eens wn oom <0 Tor oon Production Job etc) oon AntweDecae "000 ae or at oes os oot oon Cs oo <n ool 3s 002 on | Cipretestiny ows oom TM Dinky "oo os w Vous Worked "oon oon 56 Tete oon oo 2 AR R=. 13 i ecMtCsmpan iPartial R? <a <a @ <a <n 000249 . 2eaz3eVLCgoomfp|a FMiagluereEm1.p.lLoiyneeeasr,R2e0g0r0esMseidoincaMlodSeurlvoefilTlraingclegyPcreroigdreasm* by PFOA* for Antwerc: nn RT 55 * Lt. E2N] s _...ag th : . wT. aT n LARIRIS AFAR AERA wi Summary of Fit RSquare ~ 0.029 - Analysis of Variance Source Model Error CTotal DF 1 204 205 Sum of Squares 1.863 61.193 63.056 Mean Square 1.863 0299 _F Ratio 6.211 Prob>F 0.014 Tem Intercept In PFOA ParameterEstimates Estimate Std Error _tRatio Probolt 4.695 0.042 11143 <0001 0.073 0.029 249 0.014 "naturallog 000250 . Pag3eMLC1o9omfpa1n3 Figure 2. LinEemarplRoeygereess,si2o0n0o0fMTeridgilcyaclerSiudrevse"ilblyanPceFOPAro*grfoarmDecatur Male "0 x 0 soa 5 Lose gE - oh Fs Sa Ee . is : Le TH wma ouamon nw Summary of Fit RSquare 0.028 --- Analysis of Variance SMoouderlce Error CTotal DFI Sum of Squ2a.r1e6s4 Mean Sq2ua1re666F2R3at2io 213 73.969 0.347 Prob>F 214 76.133 0.013 Parameter Estimates Tem Intercept In PFOA Estimate 5.052 0.098 Std Error _t Ratio 0.041 12227 0.039 2.50 Proba|f] <.0001 0.013 *natural log 000251 . =zsg3eM1C20o0mfp1a2r . Figure 3. Linear Regression of Triglycerides" by PFOA" for Antwerp anc: Deczss--Female Employees, 2000 Medical Surveillance Program TM 0 . el : ym t ee h :n SFE t AT as sin `Summary of Fit RSquare 0078 Source Model Error C Total Analysis of Variance DF Sum of Squares Mean Square _FRatic I 2.519 2519 80I0 95 29877 0314 Prob>E 9% 32.39 0.0065 Tem Intercept In PFOA Parameter Estimates Estimate Std Error _t Ratio_Probolt 4.690 0081 58.14 <0001 0.091 0.032 2.83 0.006 *nawral log . 000252 Figure 4. Linear Regression of Triglycerides* by PFOA" for Cottage Grove Male Employees, 2000 Medical Surveillance Program 5 Ln .. 0 EN $s10t gpanara PETE . " J 3 n ~i -- RSquare 0.008 = Source Model Error C Total Tem Intercept In PFOA Analysis of Variance DF _Sum of Squares Mean Square 1 0.452 0452 129 54.251 0421 130 54.704 F Ratio 1.076 Prob>F 0.302 Parameter Estimates Estimate 5.022 0.032 Std Error _t Ratio 0.057 88.04 0.031 1.04 Prob>t] <0001 0.302 "natural log 000253