Pharmaceutical and Personal Care Products (PPCPs) in Global Surface Waters: Risk and Drivers

Pharmaceuticals and personal care products (PPCPs) are
significant
contaminants of global concern, yet their aquatic ecological risks
and associated driving factors remain poorly understood. Here, we
analyzed 190 PPCPs in surface waters across 60 countries on five continents,
screened the priority PPCP list, and identified key ecological risk
driving factors. Results showed that antihyperglycemics and antibiotics
dominated concentration profiles, while hormones and nonsteroidal
anti-inflammatory drugs (NSAIDs) posed the most severe ecological
risks. 76 PPCPs exhibited potential risks in at least one country,
with ibuprofen, 17β-estradiol, and carbamazepine identified
as critical compounds, and estrone posing high risks to aquatic ecosystems
globally. Across income levels, PPCP concentrations peaked in lower-middle-income
countries, while ecological risks were highest in upper-middle-income
regions. PPCP risks were correlated with multiple factors such as
environmental infrastructure, healthcare systems, unemployment rates,
and the Gini index. In addition, hydrological dilution and PPCP usage
were also important driving factors that might be affected by climate
change. Here, we offer the perspective that enhancing treatment capacity,
improving healthcare accessibility, mitigating socioeconomic disparities,
and adapting to climate change are imperative to mitigate PPCP risks
while advancing across many of the United Nations Sustainable Development
Goals.