The Association between the Social Determinants of Health and Urinary Phthalates among Adults: NHANES 2009-2018 Public

Abstract

Background: Phthalates are industrial chemicals used to make consumer products softer and more malleable. Phthalates are commonly found in food packaging, fragrances, pharmaceuticals, seat fabrics and interior trim of automobiles.

Methods: This study included five National Health and Nutrition Examination Survey cycles from 2009 to 2018. After limiting the study to the adult population 18 years and older that had complete information on five urinary phthalates concentrations, we had a total of 9,318 participants. The phthalate concentrations were obtained from spot urine samples. Data for education, income, and marital status were obtained from the NHANES participant demographic questionnaire. Multiple linear regression models were used to evaluate the association between income, education, and marital status and phthalate metabolites after controlling for important confounders.

Results: In this study, higher income levels were positively associated with mono carboxy-isononyl, mono carboxy-isoctyl, mono-2-ethyl-5-carboxypentyl, and mono-benzyl concentrations. In contrast, higher educational attainment was inversely associated with mono-2-ethyl-5-carboxypentyl phthalate, mono-n-butyl, and mono-benzyl. In addition, being single or never married was inversely associated with urinary levels of mono carboxy-isononyl, carboxy-isoctyl, mono-2-ethyl-5-carboxypentyl, and mono-benzyl.

Conclusion: In summary, in this national representative sample of US adults, we observed significant positive associations between income and mono carboxy-isononyl and mono carboxy-oxyoctyl. In contrast, we observed inverse associations between income and mono-2-ethyl-5-carboxypentyl, mono-n-butyl and mono-benzyl. Further research is needed to determine if other phthalates are associated with the social determinants of health.

Table of Contents

Background......................................................................................................................................................7

Methods...........................................................................................................................................................9

Data Source and Study Population......................................................................................................................9

Measurement of Exposures and Outcomes..........................................................................................................10

Covariates........................................................................................................................................................10

Statistical analyses............................................................................................................................................11

Results.............................................................................................................................................................11

Mono carboxy-isononyl phthalate association with social determinants of health..................................................12

Mono carboxy-oxyoctyl phthalate association with social determinants of health..................................................13

Mono-2-ethyl-5-carboxypentyl phthalate (MECP) association with social determinants of health...........................13

Mono-n-butyl phthalate association with social determinants of health................................................................14

Mono-benzyl phthalate association with social determinants of health.................................................................15

Discussion........................................................................................................................................................15

Conclusion........................................................................................................................................................17

References.........................................................................................................................................................17

Tables and Figures..............................................................................................................................................21

Figure 1.............................................................................................................................................................21

Table 1...............................................................................................................................................................22

Table 2...............................................................................................................................................................25

Table 3...............................................................................................................................................................26

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	phthalates social determinants of health
Committee Chair / Thesis Advisor	Terryl J Hartman, Emory University

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