In an article published on October 12, 2021, in the peer-reviewed journal Environmental Pollution, Leonardo Trasande and co-authors from the NYU Langone Medical Center, Department of Pediatrics, New York City, and University of Iowa, United States, analyze the association between phthalates exposure and adult mortality and estimate the attributable lost economic productivity due to that mortality. The scientists measured phthalate metabolite levels in 5303 adults with a median age of 57 years participating in the 2001 – 2010 US National Health and Nutrition Examination Survey (NHANES) (FPF reported here, here, and here) and linked it to data on mortality from all causes, from cardiovascular disease, and from cancer surveyed at the end of 2015. The incorporation of economic analyses in environmental health research is being seen as a powerful tool to translate scientific findings and inform policymakers (FPF reported).

Using multivariable models, Trasande et al. identified an increase in all-cause mortality with higher high-molecular weight phthalate and di-2-ethylhexylphthalate (DEHP, CAS 117-81-7) metabolite concentrations. In addition, the results indicate that phthalate exposure contributes to cardiovascular mortality in men and suggests the same for women. Elevated cardiovascular mortality was especially linked to the presence of a DEHP metabolite. By extrapolation of their data to the American population between the ages of 55 to 64, the scientists “identified 90,761–107,283 attributable deaths and $39.9–47.1 billion in lost economic productivity” per year due to these phthalate exposures. They also clarify that their study has some limitations including that spot urine analysis is limited in representing chronic cardiovascular morality. The authors highlight that “further studies are needed to corroborate observations and identify mechanisms,” but that the existing body of evidence, confirms that “regulatory action is urgently needed to reduce these preventable exposures” to phthalates.

Several recently published studies assessed human phthalate exposure and health impacts (FPF reported and here). In early 2021, a study by the European Chemicals Agency (ECHA) found that the benefits of the REACH restriction of four phthalates, including DEHP, outweigh associated costs (e.g., of finding alternatives) by more than 10-times (FPF reported). Health costs have also been estimated for the exposure to other groups of chemicals, including per- and polyfluoroalkyl substances (PFAS) (FPF reported) and endocrine-disrupting chemicals (EDCs) (FPF reported and here).



Trasande, L., M. (2021). “Phthalates and attributable mortality: A population-based longitudinal cohort study and cost analysis.” Environmental Pollution. DOI: 10.1016/j.envpol.2021.118021

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