The occurrence and fate of 48 pharmaceuticals and personal care products (PPCPs) in three wastewater treatment plants (WWTPs) located in different urbanization areas in Xiamen, China was investigated over one year. Results showed that PPCPs were widely detected, but the major PPCPs in the influent, effluent, and sludge were different. Spatial and seasonal variations of PPCP levels in the influent and sludge were observed. The removal efficiencies for most PPCPs were similar among the three WWTPs, although they employed different biological treatment processes. Furthermore, the mass loadings per inhabitant of most pharmaceuticals had a positive correlation with the urbanization levels, indicating that most pharmaceutical usage was higher in the urban core compared to the suburban zones. The total mass loadings of all the 48 PPCPs in the effluent and waste sludge showed close proportions, which suggested the importance of proper waste sludge disposal to prevent a large quantity of PPCPs from entering the environment.