Racial/ethnic disparities in the association of environmental exposure to phthalates and bisphenols mixtures with diabetes mellitus: NHANES 2013–2016

We evaluated the association between urinary concentrations of phthalates/bisphenols mixtures and diabetes mellitus (DM) and poorly controlled DM, stratified by sex, and race/ethnicity in 2718 adults from the 2013 to 2016 National Health and Nutrition Examination Survey. DM was self-reported or defined by glucose tests/hypoglycemic use. Poorly controlled DM was defined by HbA1c ≥ 8%. Principal component analyses allowed to identify three mixtures: (1) DEHP (di(2-ethylhexyl) phthalate metabolites), (2) LMW/BPs (bisphenol A, F, S, and low molecular weight phthalates), and (3) high molecular weight phthalates. Group weighted quantile sum regression showed that the DEHP mixture was associated with lower DM prevalence in women and "other races" participants. Conversely, the LMW/BPs mixture was associated with higher DM odds, mainly among Mexican Americans. Race/ethnicity seems to determine the association between the different exposure mixtures and DM prevalence and poorly controlled DM.