- • Phthalate esters metabolites in wastewater across China were measured.
- • Nationwide phthalate esters exposure was estimated for the first time.
- • Health risk of phthalate esters for children cannot be overlooked.
- • Wastewater-based epidemiology is a good tool to assess health risks of pollutants.
Phthalate esters (PAEs) are widely used in consumer and industrial products and may thus pose significant health risks. Urine analysis, which has usually been applied to assess the health risks of PAEs, has the drawback of small sample sizes and insufficient representativeness. Wastewater-based epidemiology (WBE) collects wastewater samples containing urine from the entire community and thus is more representative than urine samples. In this work, exposure levels and health risks of PAEs were estimated on a national scale for the first time through the WBE approach. Wastewater samples were collected from 54 wastewater treatment plants in 27 major cities that cover all of the geographic regions of China. The estimated ∑5PAEs exposure levels ranged from 290 μg/inh/d (Lhasa) to 3642 ± 467 μg/inh/d (Zhengzhou) with a mean level of 2184 ± 1173 μg/inh/d. Di-n-butyl phthalate accounted for the highest proportion (65%) in the total exposure level. The ∑5PAEs exposure levels in Southwest China were significantly lower than those in other regions due to the low production and consumption of plastics in the region. The health risks of PAEs were assessed by comparing the estimated daily exposure levels to the acceptable daily exposure levels. For adults, the hazard index that represents cumulative risk of PAEs was above or below 1 depending on a particular reference dose (total daily intake values or the reference dose for anti-androgenicity) that was used for risk calculation. In contrast, the hazard index was above 1 for a significant number of cities for children, regardless of which reference dose was used. The results indicate that health risks of PAE exposure in China cannot be overlooked. Children in China are under considerably greater risks than adults, which warrants further research or proper regulation of PAE use in China.