NHANES Data Support Link between Handling of Thermal Paper Receipts and Increased Urinary Bisphenol A Excretion

Some thermal paper receipts, commonly referred to as cash register receipts, contain high levels of bisphenol A (BPA). The goal of this study is to investigate whether increased contact with thermal paper receipts is associated with an increase in urinary BPA excretion. Individuals from the NHANES 2003-2004 survey were stratified based on occupation to compare urinary BPA excretion levels. The first major finding demonstrates that individuals with potential occupational exposure to thermal paper receipts are more likely to have detectable levels of urinary BPA compared to individuals with unlikely occupational exposure (p-value <0.001). The second major finding is that females with potential occupational exposure to thermal paper receipts have significantly higher levels of urinary BPA excretion (geometric mean (GM): 5.45 μg/L, 95% CI: (4.02, 7.39)) compared to females with unlikely occupational exposure (GM: 2.16 μg/L, 95% CI: (1.73, 2.70)). This association continues to remain statistically significant when controlling for creatinine, race, body mass index (BMI), and age. Notably, there was no statistically significant association between occupation and urinary BPA excretion among males. These results suggest that exposure to BPA from thermal paper should be considered when determining aggregate BPA exposure.