Wastewater-based epidemiology (WBE) is amply used for estimating human consumption of chemicals, yet information on regional variation of pharmaceuticals and their environmental fate are scarce. Thus, this study aims to estimate the consumption of three cardiovascular, four non-steroidal anti-inflammatory pharmaceuticals (NSAIDs), and four psychoactive pharmaceuticals between urban and suburban catchments in China by WBE, and to explore their removal efficiencies and ecological risks. Eleven analytes were detected in both influent and effluent samples. The estimated consumptions ranged from <MDL-1510 mg/day/1000 inh for cardiovascular pharmaceuticals, 0.140–1980 mg/day/1000 inh for anti-inflammatory pharmaceuticals, and 0.135–177 mg/day/1000 inh for psychoactive pharmaceuticals, respectively. Consumption of most psychoactive pharmaceuticals were higher in urban than in suburban catchments, while higher consumption of carbamazepine was observed in suburban than in urban areas. Furthermore, PCA analysis revealed evident variation among sampling locations in China. Significantly positive correlation (p < 0.05, r = 0.617) was found between Log Kow and removal efficiencies of the analytes, indicating physicochemical property dependent removal in WWTPs. Ecological risk assessment exhibited moderate risks for metoprolol and venlafaxine to aquatic environment. Our study discloses significant regional variation in pharmaceutical consumption in China by WBE, which could provide basis for the establishment of well-calibrated environmental and public health policies.

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