Plasticizers and Health: What the Evidence Supports

A global model attributed 356,238 deaths to DEHP exposure in 2018. What the phthalate and BPA evidence supports, and how much is modelled rather than measured.

By Hydra Editorial

A 2025 analysis in eBioMedicine estimated that exposure to DEHP, the most widely used phthalate, was associated with 356,238 deaths globally in 2018, representing 13.5% of cardiovascular deaths among people aged 55 to 64. That is a modelling estimate rather than a measured count, and understanding why matters as much as the number itself.

What are phthalates and bisphenols, and where do they come from?

Phthalates soften plastics. DEHP appears in food packaging, medical tubing, vinyl flooring, garden hoses and personal care products. Bisphenol A hardens them and lines food cans. Exposure is close to universal: BPA is detectable in urine samples from more than 90% of the US population.

The associations reported in the literature over the past 25 years include reproductive effects, asthma, obesity, and cardiovascular outcomes. The strongest human evidence is for endocrine-related endpoints, and the mechanistic case rests on oxidative stress and metabolic dysfunction.

How much confidence do these numbers deserve?

Less than the headline suggests, and the reason is instructive. The eBioMedicine figure is a global burden model: it combines IHME cardiovascular mortality data with regional DEHP exposure estimates and hazard ratios derived from published observational studies. Every layer imports its own uncertainty, and the modelling assumes a plastics-attributable fraction of 98% for DEHP metabolites.

A separate 2024 modelling analysis in the Journal of the Endocrine Society put US healthcare costs attributable to endocrine-disrupting chemicals in plastics at roughly $250 billion in 2018, using a similar exposure-response approach. Much of this body of work comes from a small number of research groups, which is not disqualifying but does mean the estimates have not been independently replicated at the same scale by fully separate teams. Observational exposure studies also struggle to separate phthalate exposure from correlated dietary and socioeconomic patterns.

What is more solidly established is the exposure side rather than the outcome side. We know these compounds are in most people, we know roughly where they come from, and we know exposure responds quickly to changing food packaging behaviour, which is the subject of the companion post to this one.

That last point is why this is a useful topic rather than an alarming one. Exposure is measurable and modifiable, even where the disease attribution remains uncertain.

The bottom line

  • A global burden model attributed 356,238 deaths in 2018 to DEHP exposure, 13.5% of cardiovascular deaths in the 55 to 64 age group
  • That figure is modelled from observational hazard ratios, not measured, and has not been independently replicated at scale
  • BPA is detectable in over 90% of US urine samples, so this is a question about exposure levels rather than exposure or none

Frequently asked questions

Are phthalates proven to cause heart disease?
No. The published estimates come from observational studies converted into burden models, which can establish association and estimate attributable fractions but cannot demonstrate causation. The authors of the 2025 eBioMedicine analysis describe it as the first global estimate of attributable cardiovascular mortality, not as proof of a causal pathway.
Is BPA-free plastic safer?
BPA-free products commonly substitute related bisphenols such as BPS and BPF, which a 2015 systematic review found have received far less study and show similar hormonal activity in laboratory assays. The absence of BPA is not the same as the absence of bisphenol exposure, and the replacement compounds have not been shown to be safer.

Sources

  1. Hyman S et al., 2025. Phthalate exposure from plastics and cardiovascular disease: global estimates of attributable mortality and years life lost. eBioMedicine 117:105730.
  2. Rudel RA et al., 2011. Food packaging and bisphenol A and bis(2-ethylhexyl) phthalate exposure: findings from a dietary intervention. Environmental Health Perspectives 119(7):914-920.
  3. Trasande L et al., 2024. Chemicals used in plastic materials: an estimate of the attributable disease burden and costs in the United States. Journal of the Endocrine Society 8(2):bvad163.
  4. Rochester JR, Bolden AL, 2015. Bisphenol S and F: A Systematic Review and Comparison of the Hormonal Activity of Bisphenol A Substitutes. Environmental Health Perspectives.
Hydra Editorial

Hydra's editorial team. We write from primary research and cite every study we rely on, with its year and journal. We quantify claims wherever the evidence allows and state plainly where it does not: where a finding rests on a small or single trial, we say so in the text rather than in a footnote.