Knowledge discovery by analysis of community wastewater reveals factors driving public health risks.

This study tested a wide range of biological and chemical biomarker groups (BCIs) in wastewater from 10 cities in England to gain a better understanding of community exposure to chemicals and health outcomes and to unravel potential associations between disease prevalence, lifestyle choices and key risk factors. For example, viral BCIs showed relatively few correlations, except for norovirus gene abundance which correlated with antibiotic concentrations. Positive correlations between nicotine/cotinine and pharma BCIs indicated smoking as widely reported risk factor in diabetes, asthma/allergies and cardiovascular diseases. Antidiabetics showed complex relationships with various BCIs, e.g. with antibiotics possibly due to diabetes being a risk factor in e.g. respiratory tract, urinary tract and skin infections. Illicit drugs correlated mainly with lifestyle indicators and other recreational substances, including alcohol metabolites and nicotine. This exploratory paper shows the enormous potential of wastewater-based epidemiology (WBE) to enhance our understanding of factors driving public health and wellbeing risks. While WBE correlations cannot imply causation, they can serve as early warning for identification of possible health risks, providing much needed community-health screening aimed at informing patient-focussed interventions.