Body burden and health risk of pharmaceuticals in elderly population: A multi-site biomonitoring study in China

Evidence suggests that pharmaceuticals (PhACs) are widespread in the environment and may pose a threat to human health. However, limited health risk assessments are available for PhAC exposure in large and multi-site populations, especially among vulnerable populations. To address this gap, we conducted biomonitoring of 46 representative PhACs in urine samples from 3096 older adults. PhAC concentrations, adjusted for urine specific gravity, were used to calculate the estimated daily intake (EDI) and assess associated health risks. All individuals had at least one PhAC detected in their urine, with the detection rates of sulfameter, acetaminophen, metformin, and sulfamonomethoxine exceeding 70 %. Median PhAC concentrations ranged from below the limit of detection to 29.79 ng/mL. The EDI values were generally low, with the exception of those of nine PhACs, whose EDI values exceeded 1000 µg/kg/day at the 99th percentile. Total antibiotic exposure posed a health risk in 13.9 % of all individuals. Amoxicillin, florfenicol, and ciprofloxacin were major contributors to the potential health risk of gut microbiota disruption. Among the non-antibiotic PhACs, acetaminophen, amantadine, and metformin posed potential health risks to 2.2 %, 1.9 %, and 0.9 % of all individuals, respectively. Overall, this study sheds light on PhAC exposure in older adults across different regions and provides valuable insights that can help with safeguarding their health.