Phthalates, chemicals additives used to make plastic household items, are widely found throughout the world in such products as cosmetics, detergents, solvents, plastic pipes, and bug repellants. Multiple studies have found a link between ingesting some kinds of phthalates and an increased risk of health conditions. An estimated exposure to phthalates can be directly attributable to plastics use and production.¹

A study from NYU Langone’s Division of Environmental Pediatrics, published in the journal Lancet eBiomedicine, looked at a phthalate called di-2-ethylhexylphthalate (DEHP), which is used to make food containers, medical equipment, and other plastic softer and more flexible. Other research has found that DEHP exposure changes how the body uses fats and sugars by affecting certain important proteins, and increases stress on the body’s cells, leading to inflammation.^2-9 Over time, this is associated with an increased risk weight gain, diabetes, atherosclerosis, and death.^10-17

A New Research Study at NYU Langone Explores Phthalate Exposure and Cardiovascular Mortality

This study is the first global estimate to date of cardiovascular mortality due to phthalates. To come to its findings the team compiled health and environmental data from both population-level surveys and cohort-specific studies to estimate DEHP exposure across 200 countries and territories.^18–21 Mortality data was obtained from the Institute for Health Metrics and Evaluation, a research group based in the United States that collects medical information on all countries and world territories to identify trends in public health.²²

Results Suggest Unequal Burdens

NYU Langone researchers estimate that DEHP exposure contributed to 356,238 deaths, or more than 13.5 percent of all global mortality from heart disease in 2018 among people ages 55 through 64. Phthalates are in widespread use globally, but South Asia, the Middle East, and East Asia bore a larger share of the death toll than others—about 73 percent of the total. The study also estimated the total years of life lost in adults aged 55 to 64. The distribution of years lost to life followed the same patterns as overall mortality, with over 7.6 of the global 10.4 million years of life lost due to DEHP exposure occurring in the Middle East, South Asia, and East Asia. Detailed results for each world region can be found in the table at the end of this section.

One possible explanation for the increased deaths in in these countries is that they face higher rates of exposure to the chemicals, perhaps because they are undergoing a boom in plastic production, or because much of global plastic waste is taken in by countries in these regions.²³ Last, because this analysis looked at burden among 55- to 64-year-olds and cardiovascular diseases are more prevalent among older groups, countries with large, aging populations may be more at risk for adverse effects of DEHP exposure.

Aggregate results for regions can be seen in the follow table: Global Cardiovascular Mortality Burden Attributable to DEHP Exposure. This table presents estimates of the cardiovascular mortality burden attributable to DEHP exposure across different global regions. The values include the estimated number of deaths, years of life lost (YLL), and the percentage of regional cardiovascular mortality that can be attributed to underlying DEHP exposure. Each row represents a specific region, with a global total provided at the bottom. Download the full table of data.

Global Cardiovascular Mortality Burden Attributable to DEHP Exposure

	Deaths	Years of life lost	Percent of regional cardiovascular mortality attributable to DEHP
Africa	37,269	1,074,196	11.84%
East Asia and the Pacific	112,160	3,447,061	13.00%
Middle East and South Asia	148,474	4,170,822	16.81%
Australia	314	9,532	12.14%
Canada	801	24,057	12.67%
Europe	27,237	839,474	8.37%
Latin America	19,744	591,503	13.50%
United States of America	10,239	316,976	10.42%
Global	356,238	10,473,621	13.50%

Mapping Attributable Mortality

To better visualize the burden of phthalates on cardiovascular mortality around the world, researchers at NYU have created an interactive map showing results from the study.

The map below represents an estimate of the number of excess deaths in 2018 among those age 55 to 64 linked to exposure of DEHP. Users can choose to see global deaths, years of life lost, or regional percent attributable mortality by choosing from the drop-down menu on the right side of the map. Users can hover over each country on the map to see the country name, and a snapshot of country-level mortality estimates.

The darker the color on the map, the higher the estimated burden.

Download all the data shown on the map.

Reducing Exposure to DEHP and Other Phthalates

More research is clearly needed, including examining the effects of exposure to other phthalates, and more regional biomonitoring surveys which measure phthalate levels in each country on earth. However, the study team believes that immediate action is needed to prevent excess deaths linked to phthalate exposure.

Strengthening global regulations to limit DEHP and other phthalates could help reduce mortality, especially in regions where these chemicals are most extensively produced. On an individual level, reducing plastic use and minimizing the purchase of plastic products and packaged foods can also help lower exposure. Addressing this issue requires both policy changes and public awareness to protect global health.

References

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