Comparative measurement and quantitative risk assessment of alcohol consumption through wastewater-based epidemiology: An international study in 20 cities

Abstract

Quantitative measurement of drug consumption biomarkers in wastewater can provide objective information on community drug use patterns and trends. This study presents the measurement of alcohol consumption in 20 cities across 11 countries through the use of wastewater-based epidemiology (WBE), and reports the application of these data for the risk assessment of alcohol on a population scale using the margin of exposure (MOE) approach. Raw 24-h composite wastewater samples were collected over a one-week period from 20 cities following a common protocol. For each sample a specific and stable alcohol consumption biomarker, ethyl sulfate (EtS) was determined by liquid chromatography coupled to tandem mass spectrometry. The EtS concentrations were used for estimation of per capita alcohol consumption in each city, which was further compared with international reports and applied for risk assessment by MOE. The average per capita consumption in 20 cities ranged between 6.4 and 44.3L/day/1000 inhabitants. An increase in alcohol consumption during the weekend occurred in all cities, however the level of this increase was found to differ. In contrast to conventional data (sales statistics and interviews), WBE revealed geographical differences in the level and pattern of actual alcohol consumption at an inter-city level. All the sampled cities were in the "high risk" category (MOE<10) and the average MOE for the whole population studied was 2.5. These results allowed direct comparisons of alcohol consumption levels, patterns and risks among the cities. This study shows that WBE can provide timely and complementary information on alcohol use and alcohol associated risks in terms of exposure at the community level.

Potential impact of the sewer system on the applicability of alcohol and tobacco biomarkers in wastewater‐based epidemiology

“…But in contrast to the low consumption volume of illicit heroin, the average daily consumption of alcohol, a legal and popular psychoactive substance, is much higher and thus makes it possible to be measured in influent wastewater samples even with direct injection LC–MS method (eg, Reid et al). Nevertheless, the uncertainty due to in‐sewer degradation and excretion factor of EtS may have contributed to the discrepancy between WBE and surveys' estimates . Therefore, it is important to (1) have field experiments to determine the realistic extent of degradation of EtS and (2) consider the impact of degradation in future WBE estimates for alcohol consumption.…”

“…The potential rapid degradation of EtS and EtG, especially EtG (Figures a and b), in the sewer system may limit their applicability as biomarkers for the estimation of alcohol consumption in the population, although both of them are still currently used in urinalysis to detect alcohol consumption in individuals . With a complete loss after only 2 hours in both RM and GS reactors, EtG is not recommended to be used to estimate alcohol consumption in WBE studies, which supports the practice in all WBE studies related to alcohol after the initial assessment of Reid et al (Table ). In general, as found in this and other studies, glucuronide compounds are very quickly transformed in wastewater, and hence are not suitable to be used as biomarkers in WBE.…”

“…Traditionally, survey methods and sales data have been used to monitor tobacco and alcohol consumption but recently wastewater analysis or wastewater‐based epidemiology (WBE) has been used as an alternative method to estimate the consumption of chemicals at the population level . There are already some WBE studies that have monitored the consumption of alcohol and tobacco in different populations, from multiple cities to music festivals . These studies were based on the measurement of the unique metabolites of ethanol, ethyl sulfate (EtS), and ethyl glucuronide (EtG), and the metabolites of nicotine, cotinine (Cot), and trans‐3′‐hydroxycotinine (HCot).…”

“…3 There are already some WBE studies that have monitored the consumption of alcohol and tobacco in different populations, from multiple cities to music festivals. [4][5][6][7] These studies were based on the measurement of the unique metabolites of ethanol, ethyl sulfate (EtS), and ethyl glucuronide (EtG), and the metabolites of nicotine, cotinine (Cot), and trans-3′-hydroxycotinine (HCot). In WBE, the use of metabolites like EtG, EtS, Cot, and HCot ( Figure 1) as biomarkers are preferable to the use of parent compounds, because it avoids the uncertainty caused by the potential direct disposal of alcohol and tobacco, cigarette stubs, or nicotine products into the sewer.…”

Levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) in raw wastewater as an innovative perspective for investigating population-wide exposure to third-hand smoke

“…However, different tobacco control policies employed in the studied countries cannot be excluded for examining the observed geographic profile. Still, similar geographical findings where higher usages in large cities than small towns were also observed for other substances, such as alcohol 42 and illicit drugs 43,44 , in different international studies based on wastewater analysis. Levels of anabasine and anatabine measured in the two small Belgian towns were very similar to those in the city of Adelaide, a large city in Australia 25 .…”