Assessing alcohol consumption through wastewater-based epidemiology: Spain as a case study

Abstract

Background: Estimating alcohol consumption in the population has received great interest given the social, health and economic problems that it generates. In this study, wastewaterbased epidemiology (WBE), an alternative method to estimate licit and illicit drug consumption rates in a given population through the analysis of chemicals and/or metabolites in wastewaters, was applied to estimate alcohol consumption at the local and national level in Spain. Methods: Composite (24-h) wastewater samples were collected at the inlet of 17 wastewater treatment plants (WWTPs) located in 13 cities for seven consecutive days in spring of 2018. The sampled area covered 12.8% of the Spanish population. Wastewater samples were analyzed by an ion-pair liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to determine the concentration of ethyl sulphate (EtS), the biomarker used to back-calculate alcohol consumption. Results: Alcohol consumption ranged from 4.5 to 46 mL/day/inhabitant. Differences in consumption were statistically significant among the investigated cities and also between weekdays and weekends. At the local level, in each investigated population WBE provided, mostly, estimates of alcohol consumption comparable to those reported by its corresponding region in the Spanish National Health Survey. Also at the national level, comparable results were obtained between WBE-derived annual consumption rate (5.7 ± 1.2 L ethanol per capita (aged 15+) and that reported for Spain in the National Health Survey (4.7 L ethanol per capita (aged 15+)). Conclusions: This is the largest WBE study carried out to date in Spain to estimate alcohol consumption rates. It confirms that this approach is useful for establishing spatial and temporal patterns of alcohol consumption which could contribute to the development of health care management plans and policies. Nevertheless, further studies are needed to reduce the uncertainties associated with WBE and to obtain more comparable data with established indicators.

Wastewater-based epidemiology, a tool to bridge biomarkers of exposure, contaminants, and human health

“…Of special interest within the analytical methods is the development sensors and aptasensors to estimate the drug consumption since they can speed even more the process and be used for "in-situ" monitoring in the WWTPs [22]. Furthermore, similar studies have achieved the estimation of the consumption of alcohol [23][24][25], caffeine [26], nicotine [24,[27][28][29], opiods [30], and psychoactive and other types pharmaceuticals [31].…”

A Framework for Public Health Authorities to Evaluate Health Determinants for Wastewater-Based Epidemiology

“…Ethyl sulfate (EtS), a minor metabolite of ethanol, has been widely used as a WBE biomarker for alcohol consumption, 4 and it is also an established biomarker used in clinical and forensic settings. 97 – 99 …”

“…Established methods exist to extract and quantify EtS in wastewater, and these have been widely applied around the globe, 4 with several studies showing comparable results to survey data. 4 , 38 , 93 …”

Biomarker selection strategies based on compound stability in wastewater-based epidemiology

“…Among them, EtG is less stable in sewage and sewer (Banks et al 2018 ) (Table 5 ), while EtS shows high stability and originates only from the human metabolism of alcohol. It is therefore considered as the best biomarker for estimating alcohol consumption (López-García et al 2020 ). Thai et al obtained a CF of 4000 by directly comparing alcohol sales data with EtS concentrations measured in sewage (Thai et al 2021 ), overcoming the low excretion rate of EtS (0.010–0.016%) (Reid et al 2011 ) and effectively improving the accuracy of alcohol consumption estimates for the Australian population.…”