Using wastewater analysis to assess the health status of two distinct populations in China

• Most indicators suggest the university population is healthier. • The younger population consume more non-aspirin NSAIDs than the normal population. • The younger population use as much caffeine and more sweeteners but less tobacco and alcohol. Wastewater-based epidemiology (WBE) is a powerful tool for monitoring biomarkers of human health conditions. The WBE approach could deliver robust public health data with high temporal and spatial resolution, making it highly effective for assessing the impact of public health interventions across different populations. This study applied WBE to compare substance use and explore public health implications across two distinct populations: a general urban population and a university population. Daily and weekly wastewater samples were collected from 2017 to 2018, originating from a wastewater treatment plant serving the urban catchment and a pump station encompassing 10 universities. Consumption of over-the-counter (OTC) medications, prescribed drugs, and chronic disease medications in these two populations were estimated. Additionally, previously published data on recreational substances, respiratory and allergy medications, sweeteners, stress markers, and anabolic steroids were analyzed to present a comprehensive overview of human lifestyles and health status. Our results indicated that the university population consumed more OTC painkillers, including ibuprofen and paracetamol, but fewer prescribed opioids, such as codeine and morphine, compared to the general population. In contrast, higher consumption of chronic disease medications in the urban catchment indicated poorer overall health compared to the younger university population. These findings highlight significant differences in pharmaceutical consumption patterns and associated public health profiles between younger and general populations. This study underscores the utility of WBE in identifying public health disparities and guiding targeted health interventions based on population-specific needs and behaviors.