Spatial distribution of groundwater fluoride and arsenic and its related disease in typical drinking endemic regions

c exposure to geogenic fluoride and arsenic iChronic exposure to geogenic fluoride and arsenic in groundwater has a deleterious influence on the health of billions of people globally. The health status of residents impacted by connected diseases is urgently needed. A twelve-year study was carried out to identify the spatial distribution pattern of high fluoride/arsenic groundwater in an arid/semi-arid area and to estimate the population exposed to related disease. A geostatistical interpolation method and a disease inversion model were used. The results indicated that fluoride/arsenic-rich groundwater primarily accumulated in basins of Shanxi Province. Groundwater fluoride exposure provided a health concern to 3.16 million persons (9.08 % of the population), including 2.50 million children at risk of dental caries. Exposure to groundwater arsenic caused a health risk to 4.38 million inhabitants (12.58 % of total), with 1.92 million at risk of lung cancer, 1.87 million at risk of bladder cancer, and 0.29 million at risk of skin cancer, respectively. The pollution and impact of groundwater fluoride and arsenic vary greatly among residents in different environments, and accurate assessment of the affected population is of great significance for residents' health and water quality management. Our research study complements the critical data on the disease risks associated with geogenic-contaminated groundwater and provides scientific basis of water quality management for policy makers.