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[Display omitted] • Non-antibiotic pharmaceuticals have higher risk than antibiotics in landfill leachates. • Population size contributed to the regional differences of pharmaceuticals in leachates. • Solid waste composition and loading affect pharmaceutical concentrations in leachate. • High level of pharmaceuticals was observed in the leachate of residual/food waste. Municipal solid waste (MSW) landfill sites have been identified as a significant source of pharmaceuticals in the environment because unused or expired pharmaceuticals are discarded into MSW, which eventually percolate into leachates. However, the contamination of pharmaceuticals in landfill leachate in China is not comprehensively understood. Previous research into factors influencing pharmaceutical concentrations focused on a limited number and type of target pollutants or restricted study area. In the present study, 66 pharmaceuticals were analyzed (including 45 antibiotic and 21 non-antibiotic pharmaceuticals, also categorized as 59 prescription and 7 non-prescription pharmaceuticals) in leachate samples from landfill sites with various characteristics in different regions of China. The results indicated that non-antibiotic pollutants were present at significantly higher concentrations than antibiotic pollutants, with median concentrations of 1.74 μg/L and 527 ng/L, respectively. Non-antibiotic pollutants also presented a higher environmental risk than antibiotic pollutants, by 2 to 4 orders of magnitude, highlighting that non-antibiotic pharmaceuticals should not be overlooked during the assessment of landfill leachate. Pharmaceutical concentrations in landfill leachate samples exhibited regional differences; the population size served by the landfills was the dominant factor contributing to the observed differences. In addition, landfill characteristics such as the solid waste composition and MSW loading can also affect pharmaceutical concentrations in landfill leachate. Despite the implementation of the classification and disposal policy of MSW in Shanghai, China since July 2019, specifying that unused or expired pharmaceuticals should be discarded as hazardous waste, high levels of pharmaceutical contaminations were detected in leachate from the main components of classified MSW (i.e., residual and food waste). These findings emphasize the importance of pharmaceutical management in solid waste systems. [ABSTRACT FROM AUTHOR]