Chapter 4. Does early life phthalate exposure mediate racial disparities in children’s cognitive abilities?


Marisa A Patti1,*, MHS, Melissa Eliot1, PhD, Nan Li1, PhD, Kimberly Yolton2, PhD, Bruce P Lanphear3,4, MPH, MD, Aimin Chen5, MD, PhD and Joseph M Braun1, RN, MSPH, PhD
1Department of Epidemiology, Brown University, Providence, Rhode Island, United States
2Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
3Child and Family Research Institute, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
4Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
5Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

Part of the book: Environmental Health: Poverty, Race and Child Health in the Time of COVID-19

Chapter DOI:


Exposure to phthalates is associated with diminished cognition. It is unknown, however, if disproportionate exposure to phthalates among racial minorities contributes to racial disparities in children’s intellectual abilities. Methods: We used data from 253 mother-child pairs in Cincinnati, OH (HOME Study, 2003-2006). We measured urinary concentrations of eleven phthalate metabolites twice during pregnancy and up to six times in childhood. We evaluated children’s cognitive abilities at ages 5 and 8 years. Using causal mediation models, we quantified covariate-adjusted direct and indirect effects of race on children’s Full Scale IQ scores for individual phthalate metabolite concentrations during gestation and childhood. Results: Average IQ scores among Black children (n=90) were 7.0-points lower (95% CI: -12, -1.8) than White children (n=145) after adjustment for socioeconomic factors. Urinary monobenzyl phthalate (MBzP) and monoethyl phthalate (MEP) concentrations during gestation and childhood were higher among Black children. We did not observe compelling evidence that phthalate mediated the race-IQ association, with the exception of MEP. Childhood MEP concentrations partially mediated the race-IQ association. For instance, the disparities in IQ scores between Black and White children would have been reduced by 1.9 points (95% CI: -4.7, 0.7) for each 10- fold reduction in urinary MEP concentrations at age 2 years. Other phthalate metabolite concentrations during pregnancy or childhood did not mediate the race-IQ association. Conclusions: We found that urinary MEP concentrations partly mediated IQ disparities among HOME Study children. Reducing exposure to some phthalates might help reduce IQ disparities among Black and White children.


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