npj Digital Medicine

Mary Regina Boland

Lena M. Davidson

Silvia P. Canelón

Jessica Meeker

Trevor Penning

John H. Holmes

Jason H. Moore


August 11, 2021



Environmental disasters are anthropogenic catastrophic events that affect health. Famous disasters include the Seveso disaster and the Fukushima-Daiichi nuclear meltdown, which had disastrous health consequences. Traditional methods for studying environmental disasters are costly and time-intensive. We propose the use of electronic health records (EHR) and informatics methods to study the health effects of emergent environmental disasters in a cost-effective manner. An emergent environmental disaster is exposure to perfluoroalkyl substances (PFAS) in the Philadelphia area. Penn Medicine (PennMed) comprises multiple hospitals and facilities within the Philadelphia Metropolitan area, including over three thousand PFAS-exposed women living in one of the highest PFAS exposure areas nationwide. We developed a high-throughput method that utilizes only EHR data to evaluate the disease risk in this heavily exposed population. We replicated all five disease/conditions implicated by PFAS exposure, including hypercholesterolemia, thyroid disease, proteinuria, kidney disease and colitis, either directly or via closely related diagnoses. Using EHRs coupled with informatics enables the health impacts of environmental disasters to be more easily studied in large cohorts versus traditional methods that rely on interviews and expensive serum-based testing. By reducing cost and increasing the diversity of individuals included in studies, we can overcome many of the hurdles faced by previous studies, including a lack of racial and ethnic diversity. This proof-of-concept study confirms that EHRs can be used to study human health and disease impacts of environmental disasters and produces equivalent disease-exposure knowledge to prospective epidemiology studies while remaining cost-effective.

From the late 1960s to 2010, two former military bases and an air guard station in the Horsham-Warminster-Warrington area used PFAS-containing foam, aqueous film forming foam (AFFF): Willow Grove Former Naval Air Station Joint Reserve Base (NASJRB), Horsham Air Guard Station (HAGS) and Former Naval Air Warfare Center (NAWC). At these sites, AFFF with PFAS was used for a number of events, including firefighter training activities, fire suppression for aircraft crashes, and spills of the contaminants on site. This resulted in direct emissions of PFAS into surface and ground water. In 2009, the EPA released a Provisional Health Advisory Level of 200 ppt for PFOS and 400 ppt for PFOA. After initial discovery of PFAS in drinking water in 2014, contaminated wells were taken off-line and public water service providers started purchasing supplemental water supply from the Forest Park Water Treatment facility through the North Wales Water Authority (NWWA). Bottled water or home water filtration systems were provided to those with contaminated private wells. In May 2016, the EPA released a lower Lifetime Health Advisory Level of 70 ppt of combined PFOS/PFOA, leading to more closures of public and private water wells. Due to the half-life of PFAS species found in the community, post-PFAS exposure may be observed 2022–2027.

Horsham-Warminster-Warrington area PFAS exposure timeline
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