Wastewater-based human gut microbiome surveillance links microbial signatures to population health in Ohio...

Wastewater-based epidemiology (WBE) has been widely used to track infectious diseases, yet its potential for population-level gut microbiome surveillance and broader public health assessment remains limited. Here, we present a multi-city study in Ohio, USA, demonstrating how sewage-derived human gut microbiome profiles can be leveraged to infer community health patterns. In this retrospective cross-sectional study, influent wastewater samples were collected from eight Ohio cities (May - June 2022). Community-level gut bacterial profiles were characterized and integrated with publicly available health, lifestyle, socioeconomic, and demographic data using geospatial analysis. Bioinformatic processing and multivariate statistical approaches, including principal component analysis and multiple linear regressions, were used to examine associations between microbial features and population health indicators. Distinct microbial signatures were observed across cities, including variation in clinically relevant taxa such as Bacteroidota, Desulfobacterota, Verrucomicrobiota, Akkermansia, Desulfovibrio, and Streptococcus. Several microbial features, including Firmicutes, Desulfovibrio, Acetobacterium, and alpha diversity, were significantly associated with indicators of chronic disease burden and health-related factors, including smoking, obesity, unemployment, and minority status. Notably, several microbial variables demonstrated statistical associations with multiple community health metrics (e.g., hypertension, high cholesterol, asthma, obesity, smoking, depression, and unemployment), and rural communities generally exhibited higher adverse health burdens alongside distinct microbiome profiles. These findings highlight the feasibility of integrating wastewater-based gut microbiome data with demographic and health indicators to evaluate community health disparities. This study expands the scope of WBE beyond infectious disease monitoring and supports its application in informing targeted and equitable public health interventions.