AUTHOR=Shao Xiaomei , Zhang Ling , Wang Yuting , Ying Youmei , Chen Xueqin 

TITLE=Developing an interpretable machine learning predictive model of chronic obstructive pulmonary disease by serum PFAS concentration

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1602566

DOI=10.3389/fpubh.2025.1602566

ISSN=2296-2565

ABSTRACT=BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with limited early detection strategies. While previous studies have examined the relationship between per- and polyfluoroalkyl substances (PFAS) and COPD, limited research has applied interpretable machine learning (ML) techniques to this association.MethodsWe investigated the association between PFAS exposure and COPD risk in 4,450 National Health and Nutrition Examination Survey (NHANES) participants from 2013 to 2018. After excluding missing covariates and extreme PFAS values and applying K-nearest neighbors (KNN) imputation, nine ML models, including CatBoost, were built and evaluated using metrics like accuracy, area under the curve (AUC), sensitivity, and specificity. The best-performing model was further analyzed using partial dependence plots (PDP) and SHapley additive exPlanations (SHAP) analysis. To enhance clinical applicability, the final model was deployed as a publicly accessible web-based risk calculator.ResultsCatBoost emerged as the best model, achieving an accuracy of 84%, AUC of 0.89, sensitivity of 81%, and specificity of 84%. PDP revealed that higher perfluorooctane sulfonic acid (PFOS) and perfluoroundecanoic acid (PFUA) levels were associated with reduced COPD risk, whereas perfluorooctanoic acid (PFOA) and 2-(N-Methyl-perfluorooctane sulfonamido) acetic acid (MPAH) showed positive associations with COPD. perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDE), and perfluorohexane sulfonic acid (PFHxS) demonstrated mixed or non-linear effects. SHAP analysis provided insights into individual predictions and overall variable contributions, clarifying the complex PFAS-COPD relationship. The deployed web-based calculator enables interactive prediction and risk interpretation, supporting potential public health applications.ConclusionCatBoost identified PFOS and PFUA as protective factors against COPD, while PFOA and MPAH increased risk of COPD. These findings emphasize the need for stricter PFAS regulation and highlight the potential of machine learning in guiding prevention strategies.