Equity in wastewater monitoring: Differences in the demographics and social vulnerability of sewered and unsewered populations across North Carolina

Wastewater monitoring is a valuable public health tool that can track a variety of health markers. The strong correlations between trends in wastewater viral concentrations and county-level COVID-19 case counts point to the ability of wastewater data to represent changes in a community’s disease burden. However, studies are lacking on whether the populations sampled through wastewater monitoring represent the characteristics of the broader community and the implications on health equity. We conducted a geospatial analysis to examine the extent to which populations contributing to wastewater collected through the North Carolina Wastewater Monitoring Network as of June 2022 represent the broader countywide and statewide populations. After intersecting sewershed boundary polygons for 38 wastewater treatment plants across 18 counties with census block and tract polygons, we compared the demographics and social vulnerability of (1) people residing in monitored sewersheds with countywide and statewide populations, and (2) sewered residents, regardless of inclusion in wastewater monitoring, with unsewered residents. We flagged as meaningful any differences greater than +/- 5 percentage points or 5 percent (for categorical and continuous variables, respectively) and noted statistically significant differences (p