Socioeconomic and health outcome associations with lifestyle choices uncovered by wastewater information mining

Wastewater-based epidemiology (WBE) represents a powerful tool for population health surveillance, however, the systematic integration of wastewater-derived human behavioural markers (WBECI) with socioeconomic and demographic data remains understudied. The aim of this study was to explore the potential of triangulating wastewater chemical markers (WBECI) with population census data to unravel associations between disease prevalence, lifestyle choices and key risk factors associated with nicotine and caffeinated product use. This was critically evaluated in a multi-city (n = 10), national level WBE study in England. Associations of different wastewater markers revealed that smoking WBECIs (nicotine and cotinine) correlate with multi-disease WBECIs (pharmaceuticals used as proxies for disease: cardiovascular diseases (CVDs, pain, asthma, diabetes, infectious disease). Smoking WBECIs also showed strong positive associations with socioeconomic and demographic indicators (ONSSEDI) such as economic deprivation, poor health and low level of education. Triangulation of WBECI and ONSSEDI indicators revealed that cities with lower education outcomes, poor health and the highest deprivation index cluster with smoking as well as with CVD, cancer, diabetes, asthma, infectious disease and pain WBECIs. Conversely, the least deprived city with the highest level of education and good health clustered with caffeine and oxidative stress, which calls for further work to confirm any causal relationships between lifestyle choices, socioeconomic background and health outcomes. Further exploration of correlations reveals pain management and antibiotics usage, illicit drug use, as well as chronic, often lifestyle driven conditions such as CVDs, diabetes, asthma and cancer cluster closely with disability, deprivation, poor health and low level of education. This is especially notable in cities with high deprivation index and could serve as an early warning for city-focussed interventions.