Association of urinary bisphenol A with cardiovascular and all-cause mortality: National Health and Nutrition Examination Survey (NHANES) 2003-2016.
Level 3 - non-randomized controlled study
Prospective cohort analysis of survey participants linked to mortality records.
PubMed 36807039 · doi:10.1007/s11356-023-25924-7
What was done
This study examined 9,243 adult participants from the National Health and Nutrition Examination Survey (NHANES) 2003–2016 linked to National Death Index mortality records through December 31, 2019. Urinary bisphenol A (BPA) concentration was measured and adjusted for urinary creatinine (BPA/Cr, ng/mg). Authors used complex sampling-weighted multivariate Cox proportional hazards models to evaluate hazard ratios (HRs) for all-cause and cardiovascular mortality across BPA/Cr quartiles over a median follow-up of 9.1 years.
What was found
Over follow-up, 1,200 all-cause deaths and 374 cardiovascular deaths occurred. Comparing the highest to the lowest BPA/Cr quartile, the adjusted HR was 1.76 (95% CI, 1.23–2.52) for cardiovascular mortality and 1.21 (95% CI, 0.98–1.49) for all-cause mortality. A significant interaction by sex was observed for cardiovascular mortality (P for interaction = 0.044): the adjusted HR in women was 2.80 (95% CI, 1.56–5.02), compared to 1.34 (95% CI, 0.79–2.24) in men.
Why it matters
It demonstrates a significant prospective link between higher environmental BPA exposure and long-term cardiovascular mortality in the US general population, suggesting potential sex-specific vulnerability in women.
Limits
Urinary BPA was assessed at a single spot-urine timepoint, which may not capture long-term exposure variations given the short half-life of BPA. As an observational study, residual confounding from dietary or other environmental co-exposures cannot be ruled out.
Cited by
- supports An NHANES study of over 9,000 participants followed for 9 years found highest urinary BPA was associated with a 1.76 times higher CVD mortality, and 2.8 times higher in women.