Abstract
Understanding factors associated with antimicrobial resistance (AMR) distribution across populations is a necessary step in planning optimal mitigation measures. While associations between AMR and socioeconomic-status (SES), including factors like income, employment, education, have been increasingly recognized in low- and middle-income settings, this interplay is less clear in high-income countries. We explored the relationship between SES and AMR in Calgary, Canada using spatially-resolved wastewater-based surveillance of resistomes detected by metagenomics across socio-economically diverse urban neighbourhoods. Conducting this comparison during the height of COVID-related international travel restrictions (Dec.2020-Oct.2021) allowed the hypotheses linking SES and AMR to be assessed with limited confounding. Wastewater metagenomes from eight diverse neighbourhoods exhibited highly similar resistomes, with no quantitative differences (p > 0.05), low Bray-Curtis dissimilarity, and no significant correlations with SES. By comparison, dissimilarity was observed between globally-sourced resistomes from 244 cities (p < 0.05), underscoring the homogeneity of resistomes in Calgary’s sub-populations. The analysis of globally-sourced resistomes alongside Calgary resistome further revealed lower AMR burden in Calgary relative to other cities around the world was particularly pronounced for some of the most clinically-relevant AMR genes (e.g., beta-lactamases, macrolide-lincosamide-streptogramin). This work showcases the effectiveness of inclusive and comprehensive wastewater-based surveillance for exploring the interplay between SES and AMR.