Wastewater treatment plants (WWTPs) have been confirmed as reservoirs of antibiotic resistance genes (ARGs). This study systematically investigated the distribution patterns of ARGs across different treatment units in municipal WWTPs, along with the environmental drivers, dissemination characteristics, and exposure risks of aerosol-borne ARGs in aerated tank environments. The results revealed a high compositional similarity in aerosol-borne ARGs across the sampling sites, with multidrug ARGs predominating at an average relative abundance of 52%, followed sequentially by tetracycline (11%), MLS (10%), and glycopeptide resistance genes (7%). The diffusion of aerosol-borne ARGs is significantly influenced by environmental factors including temperature, relative humidity, wind speed, and total suspended particulate (TSP) concentration, with temperature being the most dominant factor affecting the dispersion of ARGs. The atmospheric dispersion model demonstrates that aerosol-borne ARGs decay with increasing downwind distance, showing potential for transport from aeration tanks to locations exceeding 1500 m along the prevailing wind direction. Both within wastewater treatment units and downwind areas, adult males had higher respiratory exposure doses but lower skin contact doses compared to females, with respiratory doses exceeding skin contact by 3–4 orders of magnitude. This study highlights the potential health risks posed by aerosol-borne ARG transmission from WWTP operations.