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They’re obviously doing recommendations based on IP address. (And this is purely over ipv4).I have IPv6 at home and connect to Youtube over IPv6 (that's generally the default behaviour on macOS and many other OSes). I reboot my DSL modem-router every night and get a new IPv4 address and new IPv6 prefix every day.
Now: I live in Ontario, and my ISP is based in Ontario, but they serve clients in Quebec. Every so often, when surfing Youtube, I get served ads in French because according to my (IPv6) address I am "in" Quebec.
And, while I am not logged into any Google service, I do not block cookies. So even with cookies, Youtube seems to be fairly dumb about serving ads correctly just based on IP addresses (or at least IPv6 addresses and/or IPv6 prefixes), since cookies don't seem to be useful.
So I'm not quite sure about what people are talking about when they say "IPv6 tracking" if even Google/Youtube can't get their act together.