This narrative review synthesizes evidence on human health risks linked to emissions from municipal, hazardous and medical waste incinerators up to August 2025. For the search of information, the databases PubMed, Scopus, Web of Science, and Google Scholar were used. The analysis reveals meaningful differences in health outcomes depending on the age and emission control technology of facilities. Evidence from older, high-emission incinerators indicates elevated cancer risks, particularly for soft tissue sarcoma, non-Hodgkin’s lymphoma, and respiratory cancers in exposed communities. The evidence for adverse reproductive outcomes, including birth defects and adverse birth outcomes, is limited and inconsistent. Respiratory disease and symptoms have been reported in some populations living near older incinerators. Workers at incineration facilities show consistent evidence of elevated exposure to carcinogenic compounds. In contrast, studies on modern waste-to-energy plants with advanced emission controls show substantially diminished or limited health risks. However, the evidence base for newer facilities remains relatively small, and long-term health effects are not yet fully established. Major methodological limitations include crude exposure assessment (reliance on residential proximity), inadequate control for confounding factors, ecological study designs, and heterogeneity in study methods. This review highlights the critical importance of technological advancement in reducing health risks, while underscoring the need for continued surveillance, especially in regions with aging infrastructure or inadequate regulatory oversight.

Importance: Phthalate exposure has been found to be associated with an increased risk of obesity. It remains unknown whether exposure to phthalates further impact the health of individuals who are already obese. Objective: To examine the risk of mortality associated with phthalate exposure among individuals with overweight and obesity. Design: A nationally representative sample of adults aged 40 years or older who participated in the US National Health and Nutrition Examination Survey 2001–2010 and provided urine samples for phthalate metabolite measurements. These participants were linked to mortality data from the survey date through December 31, 2019. Exposures: Phthalate metabolites in urine samples were measured by high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry. Main Outcome Measures: Mortality from all causes, cardiovascular disease (CVD), and cancer. Results: This cohort study included 3,845 adults aged 40 years or older (mean age 56.5 [0.3] years). During 46,261 person-years of follow-up (median 12 years; maximum 19 years), 990 deaths occurred, of which 304 were from CVD and 246 were from cancer. Elevated concentrations of high-molecular-weight (HMW) urinary phthalate metabolites and di-2-ethylhexylphthalate (DEHP) were associated with a 46% and 36% increased risk of all-cause mortality, respectively. Regarding low-molecular-weight (LMW) phthalates, higher exposure was specifically linked to a 43% excess risk of CVD mortality. Bayesian kernel machine regression (BKMR) analyses indicated a 7.3% increase in all-cause mortality associated with phthalate co-exposure (75th vs. 50th percentile). Conclusions and Relevance: In this nationally representative study, phthalate co-exposure was significantly positively associated with all-cause and CVD mortality among individuals with overweight and obesity. Higher levels of HMW and DEHP exposure were linked to increased all-cause mortality, while high LMW exposure was associated with elevated CVD mortality. Further studies are necessary to confirm these findings and investigate the underlying mechanisms.

Background: Preconception exposure to residential outdoor neighbourhood environments can influence perinatal outcomes by influencing fertility, gamete quality and foetal development through mechanisms such as oxidative stress, epigenetics and inflammation. Following our published protocol, this scoping review aims to synthesize the available evidence and identify gaps in the current understanding of this topic. Methods: We searched four databases (Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, Ovid Embase and Scopus) for peer-reviewed publications on 20 December 2023. The search was restricted to English, without other restrictions. Two reviewers independently screened titles, abstracts and full texts. Findings were narratively synthesised. Results: We identified 82 eligible studies since 2010, all but one from upper-middle-or high-income countries. The largest proportion (43%) comprised retrospective cohort studies, with number of studies published since 2020 trending upwards. Although preconception was usually defined as the three months before pregnancy, most studies assigned these exposures using pregnancy or birth addresses, assuming residential stability since preconception. Among included studies, exposure to PM2.5 was associated with an increased risk of gestational diabetes mellitus (GDM), while PM10 was linked to birth defects. However, most exposure-outcome associations were inconsistent across included studies. The literature suggested the strongest consistency for PM10-birth defects associations, while evidence for O3-GDM associations was inconclusive. Research on other outdoor environmental factors, such as noise, light pollution, weather, built and natural environments, was lacking. Conclusions: Our review found that the existing evidence base is geographically skewed, concentrated on air pollution exposures, and notably lacking in research on paternal exposures. To advance the field, future studies should adopt more precise exposure assessments and expand the range of environmental factors, geographical diversity, and paternal exposure research.