A new wide-scope, multi-biomarker wastewater-based epidemiology analytical method to monitor the health and well-being of inhabitants at a metropolitan scale

This manuscript establishes a new, comprehensive biomarker list and a multiresidue trace quantification method for community-wide health and well-being assessment at a metropolitan scale using wastewater-based epidemiology (WBE) and mass spectrometry pipelines. This method enables the quantification of 204 biochemical indicators (BCIs) across a range of biomarker classes within influent wastewater and includes illicit drug BCIs, pharmaceuticals as proxies for disease, health markers (hormones, oxidative stress, lipid peroxidation, etc.), Lifestyle chemicals, food BCIs, and hazardous chemicals in personal care products. This method facilitates the combined assessment of community exposure to chemicals and the effects of this exposure in the same framework. The method enables full quantification of 141 BCIs with method detection Limits varying from 0.01 ng/L for amlodipine to 23.8 ng/L for stachydrine. Total average method accuracies were 102.7% whereas precision was 10.4%. During an initial assessment of this method to test its suitability, 62% of all targets were detected and quantified during a week-long feasibility study of a large city with weekly average Daily BCI loads ranging from 40.0 ± 20.0 mg/day for salbutamol to 5836.5 ± 1697.1 g/day for creatinine. The inclusion of new endogenous markers such as advanced glycation end products, detected in wastewater for the first time, enables more accurate determination of community-level health and lifestyle habits. Alongside an unbiased and comprehensive health assessment through endogenous markers, health is further assessed via the use of pharmaceuticals, acting as a proxy for health and disease status whilst additionally providing insights into community lifestyle habits through the monitoring of licit/illicit drug use and food consumption. The analysis of all biomarker classes combined aims to provide insights to exposure and health effect outcomes at the community level.