A Critical Review of Populations with Occupational Exposure to Per- and Polyfluoroalkyl Substances: External Exposome, Internal Exposure Levels, and Health Effects

The relationship between per- and polyfluoroalkyl substances (PFAS) exposure and human health has received widespread attention. This review focuses on the key distinctions in PFAS exposure between the occupational population and the general population from different countries. A systematic summary is made from the external exposure environment, exposure pathways, internal exposure levels, and health effects of the occupational population. The manufacturing, use, and disposal processes of PFAS increase their concentration levels in the ambient environment, leading to significantly higher concentrations than background areas. Different PFAS exposure pathways may lead to different molecular initiating events and health outcomes in the occupational population and the general population. Moreover, the PFAS exposure levels of the occupational population are nearly one hundred times higher than those of the general population. Mixed exposure to more unknown PFAS is another important feature of the occupational population. Although occupational exposure to PFAS is not associated with mortality, PFAS exposure can significantly disrupt metabolic pathways and cause adverse effects on the liver, kidney, and lipid homeostasis. Therefore, more stringent occupational protections for the PFAS occupational population are necessary to reduce their health risks.