Quantifying the metabolic health burden of increased BPA/BPF/BPS endocrine-disrupting chemical exposure: A temporal and cross-country comparative analysis from 2000 to 2024
Marta Jaskulak, Katarzyna Zorena
Abstract
BACKGROUND: Exposure to endocrine-disrupting chemicals (EDCs), particularly bisphenol compounds such as bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF), has been linked to metabolic disorders including obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS). While regulatory actions have targeted BPA, substitution with unregulated analogues has proliferated globally. No comprehensive international analysis has quantified the disease and economic burden attributable to these exposures. OBJECTIVES: Study aims to estimate the global and regional burden of metabolic disease attributable to BPA, BPS, and BPF exposure from 2000 to 2025, and to assess the effectiveness of regulatory policies in mitigating health impacts. METHODS: Data from NHANES, HBM4EU, and regional studies with meta-analytic relative risks for BPA, BPS, and BPF associated with obesity, T2DM, and MetS were analyzed. Attributable cases were computed using population-attributable fractions (PAFs) across five global regions. Economic costs were estimated using cost-of-illness models with direct and indirect components. The policy effect of BPA bans was examined using time-trend regressions, substitution analyses, and cross-country comparisons to examine the policy effect of BPA bans. RESULTS: The total global burden of bisphenol-attributable metabolic disease rose from 68 million cases in 2000 to 127 million in 2024, including 72 million cases of obesity, 24 million of T2DM, and 31 million of MetS. Corresponding global costs are projected to exceed $1.1 trillion USD in 2024. Asia accounted for 45 % of the global burden, followed by North America and Europe. BPA-specific bans in Europe reduced BPA exposure by 33 % (p < 0.01), but resulted in a 47 % increase in BPS levels and 22 % increase in BPF, with 76 % of the bisphenol-related burden now attributed to BPS/BPF. Time-trend regressions showed statistically significant annual increases in attributable cases (p < 0.001), while regional burden differences correlated with regulatory stringency (ρ = 0.84, p < 0.001). Sensitivity analyses indicated that a 50 % reduction in exposure could avert 49 million cases and save $420 billion annually. CONCLUSIONS: Bisphenol compounds collectively pose a substantial and rising burden on global metabolic health. BPA-specific regulations have achieved limited success due to analog substitution. Effective reduction in disease burden requires class-based regulatory strategies encompassing all bisphenol analogues. CLINICAL TRIAL NUMBER: Not applicable.