First comprehensive study of alcohol consumption in Italy using wastewater-based epidemiology

Abstract

Alcohol use has increased in the last years and is a priority public health issue worldwide. Wastewater-based epidemiology (WBE) is a reliable approach for estimating substance use at the population level and can complement population surveys and sales statistics to obtain objective and updated information on alcohol use in a community. This work reports the first nationwide study of alcohol consumption conducted in Italy by WBE, covering 11.4% of the Italian population. A total of 264 raw wastewater samples (24-h composite) were collected from 17 Italian cities in 2013–2014 and one large city (Milan) over a 7-year period (2013–2019). Besides of normal days, special periods/events (i.e. Halloween, Milan Fashion Week and summer holidays) were studied in Milan. The urinary biomarker of ethanol (namely, ethyl sulphate) was measured by liquid chromatography-tandem mass spectrometry and was used to estimate alcohol consumption. Results were statistically evaluated to assess spatial and temporal differences and were compared with data from other epidemiological indicators. In 2013, alcohol consumption was significantly higher in small cities than in large ones but no significant differences were observed in relation to the geographical position. An increase in alcohol use was observed in seven large cities from 2013 to 2014. The 7-year monitoring in Milan showed no marked changes, except for remarkable increases in 2014 and 2019. Alcohol consumption significantly increased (ca. 25%) during weekends in Italy and in Milan, and during special periods/events, for instance summer holidays and Halloween. WBE estimates were in agreement with national prevalence data, demonstrating that WBE is suitable for objectively evaluating geographic, annual and weekly patterns of alcohol consumption at local and national scales. WBE information would be helpful to implement and evaluate measures for reducing alcohol consumption and preventing the related health risks.