This article confirms a series of previous articles published by Dr. Leonardo Trasande's group at New York University (NYU) and the main novelty is that it extends the conclusions to 38 countries (they had only been studied in one specific country). The results are clear and indicate, as previously published, that exposure to these compounds is associated with increased morbidity and mortality and that their economic cost is very high. Importantly, exposure in the US and Canada has decreased due to regulations and voluntary actions at the individual level.

It should be noted that the associations they establish do not imply causality, but that there is sufficient evidence from a multitude of epidemiological studies in humans and a large number of studies in animal and cellular models where these chemical compounds, common in plastics, cause cardiovascular disease, diabetes and obesity.

An important point that the authors highlight in the discussion and that had already been published even by UNEP (UN Environmental Programme) is that 70% of the chemical compounds in plastic have not been tested and therefore we do not know whether they are safe for health or not.

Such studies are based on estimates of the fraction of cases attributable to exposure levels. In this case they are based on a couple of solid, well-published papers from Dr. Trasande's group. Although these previous studies are very reliable, it is possible that the figures may change if other papers are used. However, such studies always have uncertainty in estimating health effects and it is very difficult or impossible to know what percentage of the disease is due to exposure.