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.