Study of Contaminants in Iranian Drinking Water and their Health Outcomes: A Review

Document Type : Review Paper


Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran


Contamination of ground and surface water resources with Nitrate (NO3), Fluoride (F), Trihalomethanes (THMs), radon, and heavy metals is the most important global concern due to its possible health risks to people. This study reviews the drinking water contaminants and their health outcomes examined in Iran. A review search was conducted using Scopus, Web of Knowledge, PubMed, and Embase databases for associated released articles from 2014 to 2023, resulting in 86 articles relevant to the objective of this study. 
According to the results of this review, different emerging contaminants were found in potable water, including THMs, NO3, F, radon and heavy elements (i.e., As,  Pb, Ni, Cd, Zn, Cu, and Cr). Health outcomes of exposure to radon, F, NO3, THMs, and heavy metals in potable water have been expressed in various epidemiological research studies. More than 65% of the studies reported hazard index (HI) or hazard quotient (HQ) of heavy elements to be greater than one in potable water in Iran for infants, children, teenagers, and adults. Children and infants are at higher health risk than adults in these areas.
 The level of Arsenic, Cadmium, Lead, Nickel, Zinc, and Chromium, in 26, 26, 17.39, 13.04, 8.69, and 4.3% of the papers was more than the allowable limits, respectively. Various groups of emerging pollutants have been found in potable water in Iran, while epidemiological research studies on their health outcomes are still insufficient.


Main Subjects

Abbasnejad, B., Abbasnejad, A., & Derakhshani, R. (2022). Groundwater evaluation of northern jazmourian (south iran) for drinking, agriculture, and associated health risks of nitrate and fluoride contamination. Hum. Ecol. Risk. Assess,29( 1),36-57.
Abdulkhaleq Alalwan, H., Alminshid, A.H., Mustafa Mohammed, M., Mohammed, M.F., & Hatem Shadhar, M. (2022). Reviewing of using nanomaterials for wastewater treatment. Pollution, 8 (3), 995-1013.
Abedi Sarvestani, R., & Aghasi, M. (2019). Health risk assessment of heavy metals exposure (lead, cadmium, and copper) through drinking water consumption in kerman city, iran. Environ. Earth. Sci, 78, 1-11.
Abu-Khader, M.M., Shawaqfeh, A.T., Naddaf, Z., Maity, J.P., & Bhattacharya, P. (2018). Radon in the groundwater in the amman-zarqa basin and related environments in jordan. GroundW. Sustain.Dev, 7, 73-81.
Abuelhia, E. (2019). Assessment of radiation dose from radon ingestion and inhalation in commercially bottled drinking water and its annual effective dose in eastern province, saudi arabia. Int .J. Environ.Health .Res, 29 (2), 164-172.
Adeyeye, O.A., Xiao, C., Zhang, Z., Yawe, A.S., & Liang, X. (2021). Groundwater fluoride chemistry and health risk assessment of multi-aquifers in jilin qianan, northeastern china. Ecotoxicol.Environ.Safe, 211, 111926.
Adimalla, N. (2020). Spatial distribution, exposure, and potential health risk assessment from nitrate in drinking water from semi-arid region of south india. Hum. Ecol. Risk assess, 26 (2), 310-334.
Adinehvand, K., Azadbakht, B., & Yekta, M.F. (2019). Dose assessment and measurement of radon concentration in water supplies of borujerd county in iran. Int.J.Radiat .Res, 17 (3), 507-511.
Adinehvand, K., Sahebnasagh, A., & Hashemi-Tilehnoee, M.(2016). Radon concentration in the drinking water of aliabad katoul, iran. Iran.Red .Crescent. Med.J, 18 (7).
Aghapour, S., Bina, B., Tarrahi, M.J., Amiri, F., & Ebrahimi, A, (2018). Distribution and health risk assessment of natural fluoride of drinking groundwater resources of isfahan, iran, using gis. Environ. Monit.Assess, 190, 1-13.
Aghapour, S., Bina, B., Tarrahi, M.J., Amiri, F., & Ebrahimi, A.(2021). Comparative health risk assessment of nitrate in drinking groundwater resources of urban and rural regions (isfahan, iran), using gis. Environ.Monit..Assess, 193, 1-17.
Ahada, C.P., & Suthar, S.(2018). Groundwater nitrate contamination and associated human health risk assessment in southern districts of punjab, india. Environ. Sci. pollut.Res, 25 (25), 25336-25347.
Ahamad, A., Raju, N.J., Madhav, S., & Khan, A.(2020). Trace elements contamination in groundwater and associated human health risk in the industrial region of southern sonbhadra, uttar pradesh, india. Environ.Geochem.Health, 42 (10), 3373-3391.
Ali, S., Ghezelsofla, M., Keramati, H., Moradi, B., & Fakhri, Y.( 2018). Dataset on non-carcinogenic risk via nitrate and nitrite in the groundwater of divandarreh county, kurdistan province, iran: A potential concern for drinking. Data in brief, 20, 1822-1828.
Alidadi, H., Tavakoly Sany, S.B., Zarif Garaati Oftadeh, B., Mohamad, T., Shamszade, H., & Fakhari, M.(2019). Health risk assessments of arsenic and toxic heavy metal exposure in drinking water in northeast iran. Environ.Health .Prev.Med, 24, 1-17.
Amini, H., Taghavi Shahri, S.M., Amini, M., Ramezani Mehrian, M., Mokhayeri, Y., & Yunesian, M.(2011). Drinking water fluoride and blood pressure? An environmental study. Biol.Trace. Elem. Res, 144, 157-163.
Arman, K., Pardakhti, A., Osoleddini, N., & Leili, M.(2016). Cancer risk assessment from multi-exposure to chloroform in drinkingwater of ilam city, iran. Avicenna. J. Environ. Health. Eng, 3(1), 5331.
Azhdarpoor, A., Radfard, M., Pakdel, M., Abbasnia, A., Badeenezhad, A., Mohammadi, A.A., & Yousefi, M.(2019). Assessing fluoride and nitrate contaminants in drinking water resources and their health risk assessment in a semiarid region of southwest iran. Desalin .Water. Treat, 149, 43-51.
Babaei, A.A., Alavi, N., Hassani, G., Yousefian, F., Shirmardi, M., & Atari, L.(2015). Occurrence and related risk assessment of trihalomethanes in drinking water, ahvaz, iran. Fresenius. Environ. Bull, 24 (12c), 4807-4815.
Badeenezhad, A., Radfard, M., Abbasi, F., Jurado, A., Bozorginia, M., Jalili, M., & Soleimani, H.(2021). Effect of land use changes on non-carcinogenic health risks due to nitrate exposure to drinking groundwater. Environ.Scie.Pollut. Res, 28, 41937-41947.
Barzegar, R., Asghari Moghaddam, A., Adamowski, J., & Nazemi, A.H.(2019a). Assessing the potential origins and human health risks of trace elements in groundwater: A case study in the khoy plain, iran. Environ.Geochem.Health, 41, 981-1002.
Barzegar, R., Asghari Moghaddam, A., Soltani, S., Fijani, E., Tziritis, E., & Kazemian, N.(2019b). Heavy metal (loid) s in the groundwater of shabestar area (nw iran): Source identification and health risk assessment. Expos .Health, 11, 251-265.
Cho, B.W., Kim, H.K., Kim, M.S., Hwang, J.H., Yoon, U., Cho, S.Y., & Choo, C.O.(2019). Radon concentrations in the community groundwater system of south korea. Environ.Monit.Assess., 191, 1-10.
Cotruvo, J.A.(2017) who guidelines for drinking water quality: First addendum to the fourth edition. J.Am. Water .Work.Associ, 109 (7), 44-51.
Darabi Fard, Z., Rahimi, M., Malakootian, M., & Javid, N.(2020). Studying radon concentration in drinking water resources in zarand city (iran) and its villages. J. Radioanal.Nucl. Chem, 326, 33-39.
Dashtizadeh, M., Kamani, H., Ashrafi, S.D., Panahi, A.H., Mahvi, A.H., Balarak, D., Hoseini, M., Ansari, H., Bazrafshan, E., & Parsafar, F.(2019). Human health risk assessment of trace elements in drinking tap water in zahedan city, iran. J.Environ.Health. Sci.Eng, 17, 1163-1169.
Daud, M., Nafees, M., Ali, S., Rizwan, M., Bajwa, R.A., Shakoor, M.B., Arshad, M.U., Chatha, S.a.S., Deeba, F., & Murad, W.(2017). Drinking water quality status and contamination in pakistan. BioMed .Res. Int, 2017.
Dehbandi, R., Moore, F., & Keshavarzi, B.(2018). Geochemical sources, hydrogeochemical behavior, and health risk assessment of fluoride in an endemic fluorosis area, central iran. Chemosphere, 193, 763-776.
Dehghani, M.H., Zarei, A., Yousefi, M., Asghari, F.B., & Haghighat, G.A., 2019. Fluoride contamination in groundwater resources in the southern iran and its related human health risks. Desalin.Water Treat, 153, 95-104.
Duggal, V., Rani, A., Mehra, R., & Balaram, V.(2017). Risk assessment of metals from groundwater in northeast rajasthan. J.Geol.Soc.India, 90 (1), 77-84.
Eslami, H., Esmaeili, A., Razaeian, M., Salari, M., Hosseini, A.N., Mobini, M., & Barani, A.(2022). Potentially toxic metal concentration, spatial distribution, and health risk assessment in drinking groundwater resources of southeast iran. Geosci.Front 13 (1), 101276.
Essien, E.E., Said Abasse, K., Côté, A., Mohamed, K.S., Baig, M.M.F.A., Habib, M., Naveed, M., Yu, X., Xie, W., & Jinfang, S.(2022). Drinking-water nitrate and cancer risk: A systematic review and meta-analysis. Arch. Environ. Occup.Health, 77 (1), 51-67.
Evans, S., Campbell, C., & Naidenko, O.V.(2020). Analysis of cumulative cancer risk associated with disinfection byproducts in united states drinking water. Int.J. Environ.Res.Public. Health, 17 (6), 2149.
Fadaei, A.(2021). Comparison of water defluoridation using different techniques. Int.J.Chem.Eng, 2021.
Fadaei, A.(2022). An investigation into the present levels of contamination in children’s toys and jewelry in different countries: A systematic review. Reviews . Environ.Health.
Fadaei, A., & Sadeghi, M.(2014). Evaluation and assessment of drinking water quality in shahrekord, iran. Resour.Environ, 4 (3).
Fakhri, Y., Conti, G.O., Ferrante, M., Bay, A., Avazpour, M., Moradi, B., Zandsalimi, Y., Amirhajeloo, L.R., Langarizadeh, G., & Keramati, H.(2016a). Assessment of concentration of radon 222 and effective dose; bandar abbas city (iran) citizens exposed through drinking tap water. Int.J.Pharm.Technol, 8 (1), 10782-10793.
Fakhri, Y., Kargosha, M., Langarizadeh, G., Zandsalimi, Y., Amirhajeloo, L.R., Moradi, M., Moradi, B., & Mirzaei, M.(2016b). Effective dose radon 222 of the tap water in children and adults people; minab city, iran. Global .j.Health. Sci, 8 (4), 234.
Fakhri, Y., & Mirzaei, M.(2015). Determination concentration of radon 222 in tap drinking water, jask city, iran. IOSR J. Environ.Sci, Toxicol. Food. Technol, 9 (8), 6-9.
Fallahzadeh, R.A., Khosravi, R., Dehdashti, B., Ghahramani, E., Omidi, F., Adli, A., & Miri, M.(2018). Spatial distribution variation and probabilistic risk assessment of exposure to chromium in ground water supplies; a case study in the east of iran. Food .Chem.Toxicol, 115, 260-266.
Farimani Raad, H., Pardakhti, A., & Kalarestaghi, H.(2021). Carcinogenic and non-carcinogenic health risk assessment of heavy metals in ground drinking water wells of bandar abbas. Pollution, 7 (2), 395-404.
Fathmawati, Fachiroh, J., Gravitiani, E., Sarto & Husodo, A.H.(2017). Nitrate in drinking water and risk of colorectal cancer in yogyakarta, indonesia. J.Toxicol.Environ.Health, Part A, 80 (2), 120-128.
Ghaderpoori, M., Paydar, M., Zarei, A., Alidadi, H., Najafpoor, A.A., Gohary, A.H., & Shams, M.)2019(. Health risk assessment of fluoride in water distribution network of mashhad, iran. Hum.Ecol.Risk Assess, 25 (4), 851-862.
Ghahramani, E., Maleki, A., Kamarehie, B., Azimi, F., & Karami, M.A.)2020(. Determination of heavy metals concentration in drinking water of rural areas of divandarreh county, kurdistan province: Carcinogenic and non‑carcinogenic health risk assessment. Int. J. Environ. Health. Eng.,14,1-9.
Giri, S., & Singh, A.K.(2015). Human health risk assessment via drinking water pathway due to metal contamination in the groundwater of subarnarekha river basin, india. Environ.Monit. Assess, 187 (3), 1-14.
Giwa, A.S., Memon, A.G., Ahmad, J., Ismail, T., Abbasi, S.A., Kamran, K., Wang, B., Segun, B., & Seydou, H.(2021). Assessment of high fluoride in water sources and endemic fluorosis in the north-eastern communities of gombe state, nigeria. Environ.Pollut.Bioavailab, 33 (1), 31-40.
Golaki, M., Azhdarpoor, A., Mohamadpour, A., Derakhshan, Z., & Conti, G.O.(2022). Health risk assessment and spatial distribution of nitrate, nitrite, fluoride, and coliform contaminants in drinking water resources of kazerun, iran. Environ. Res, 203, 111850.
Gugulothu, S., Subba Rao, N., Das, R., Duvva, L.K., & Dhakate, R.(2022). Judging the sources of inferior groundwater quality and health risk problems through intake of groundwater nitrate and fluoride from a rural part of telangana, india. Environ.Sci.Pollut.Res, 1-22.
Hameed, A., Nazir, S., Rehman, J.U., Ahmad, N., Hussain, A., Alam, I., Nazir, A., & Tahir, M.B.(2021). Assessment of health hazards related to contaminations of fluorides, nitrates, and nitrites in drinking water of vehari, punjab, pakistan. Hum.Ecol.Risk. Assess, 27 (6), 1509-1522.
Hussain, S., Habib-Ur-Rehman, M., Khanam, T., Sheer, A., Kebin, Z., & Jianjun, Y.(2019). Health risk assessment of different heavy metals dissolved in drinking water. Int.J.Environ. Res. Public. Health, 16 (10), 1737.
Im, J.K., Cho, Y.C., Kim, Y.S., Lee, S., Kang, T., & Kim, S.H.(2022). Characteristics, possible origins, and health risk assessment of trace elements in surface waters of the han river watershed, south korea. Int.J.Environ.Res.Public. Health, 19 (23), 15822.
Inácio, M., Soares, S., & Almeida, P.(2017). Radon concentration assessment in water sources of public drinking of covilhã’s county, portugal. J. Radiat. Res.Appl.Sci, 10 (2), 135-139.
Iran, I.(2010). O. S. A. Ir o., drinking water-physical and chemical specifications. Institute of Standards and Industrial Research of Iran Tehran.
Jaafarzadeh, N., Panahi Fard, M., Jorfi, S., & Zahedi, A.(2021). Carcinogenic risk assessment of nitrate contamination of drinking water resources in south provinces of iran. Int.J.Environ. Anal. Chem, 1-10.
Jahani, H., Mohammadi, A., Khatibi, M.S., Sabeti, Z., & Mosaferi, M.(2022). Spatial trend and probabilistic health risk assessment of heavy metals, nitrate, and fluoride in groundwater resources, west azerbaijan province, iran.Environ.Sci.Pollut.Res
Jamshidi, A., Morovati, M., Golbini Mofrad, M.M., Panahandeh, M., Soleimani, H., & Abdolahpour Alamdari, H.(2021). Water quality evaluation and non-cariogenic risk assessment of exposure to nitrate in groundwater resources of kamyaran, iran: Spatial distribution, monte-carlo simulation, and sensitivity analysis. J.Environ.Health Sci.Eng, 19 (1), 1117-1131.
Kalteh, S., Hamidi, F., Nasab, M.A., Gharibdoosti, N.M., Ghalhari, M.R., Parvizishad, M., & Mahvi, A.H., (2022) Quantification and health risk assessment of nitrate in southern districts of tehran, iran. Water Reuse, 12 (2), 274-288.
Karimzade, S., Aghaei, M., & Mahvi, A.(2014). Investigation of intelligence quotient in 9–12-year-old children exposed to high-and low-drinking water fluoride in west azerbaijan province, iran. Fluoride, 47 (1), 9-14.
Kazemi, A., Esmaeilbeigi, M., Sahebi, Z., & Ansari, A.(2022). Health risk assessment of total chromium in the qanat as historical drinking water supplying system. Sci.Total .Environ, 807, 150795.
Keramati, H., Ghorbani, R., Fakhri, Y., Khaneghah, A.M., Conti, G.O., Ferrante, M., Ghaderpoori, M., Taghavi, M., Baninameh, Z., & Bay, A.(2018). Radon 222 in drinking water resources of iran: A systematic review, meta-analysis and probabilistic risk assessment (monte carlo simulation). Food .Chem.Toxicol, 115, 460-469.
Keshavarz, S., Ebrahimi, A., & Nikaeen, M.(2015). Fluoride exposure and its health risk assessment in drinking water and staple food in the population of dayyer, iran, in 2013. J.Educ. Health Promot,4(72),1- 7.
Khaled, S., Khaled, A., Shaban, R., & Baset, A.A.(2020). Measurement of 222rn concentration levels in drinking water samples from qena city (egypt) and evaluation of the annual effective doses. Int.J. Radiat. Res, 18 (2), 227-233.
Khan, A.F., Srinivasamoorthy, K., Prakash, R., Gopinath, S., Saravanan, K., Vinnarasi, F., Babu, C., & Rabina, C.(2021). Human health risk assessment for fluoride and nitrate contamination in the groundwater: A case study from the east coast of tamil nadu and puducherry, india. Environ.Earth .Sci, 80 (21), 1-17.
Khan, S., Rauf, R., Muhammad, S., Qasim, M., & Din, I.(2016). Arsenic and heavy metals health risk assessment through drinking water consumption in the peshawar district, pakistan. Hum.Ecol.Risk .Assess, 22 (3), 581-596.
Kom, K.P., Gurugnanam, B., & Bairavi, S.(2022). Non-carcinogenic health risk assessment of nitrate and fluoride contamination in the groundwater of noyyal basin, india. Geod.Geodyn, 13 (6), 619-631.
Królak, E., & Raczuk, J.(2018). Nitrate concentratio-related safety of drinking water from various sources intended for consumption by neonates and infants. Arch.Environ.Prot, 44 (1),3-9.
Kujlu, R., Mahdavianpour, M., & Ghanbari, F(2020). Multi-route human health risk assessment from trihalomethanes in drinking and non-drinking water in abadan, iran. Environ.Sci.Pollut.Res, 27 (34), 42621-42630.
Kuluöztürk, M.F., Büyüksaraç, A., Özbey, F., & Yalçin, S.(2017). Determination of radon gas activity levels in drinking water in ahlat/bitlis. BEU.J.Sci  .Technol, 7 (2), 104-107.
Kumari, M., Gupta, S., & Mishra, B.(2015). Multi-exposure cancer and non-cancer risk assessment of trihalomethanes in drinking water supplies–a case study of eastern region of india. Ecotoxicol.Environ.Safe, 113, 433-438.
Lee, C.-M., Hamm, S.-Y., Cheong, J.-Y., Kim, K., Yoon, H., Kim, M., & Kim, J.(2020). Contribution of nitrate-nitrogen concentration in groundwater to stream water in an agricultural head watershed. Environ.Res, 184, 109313.
Li, P., He, X., Li, Y., & Xiang, G.(2019). Occurrence and health implication of fluoride in groundwater of loess aquifer in the chinese loess plateau: A case study of tongchuan, northwest china. Expos. Health, 11 (2), 95-107.
Liu, Y., & Ma, R.(2020). Human health risk assessment of heavy metals in groundwater in the luan river catchment within the north china plain. Geofluids, 2020.
Magesh, N., Chandrasekar, N., & Elango, L.(2017). Trace element concentrations in the groundwater of the tamiraparani river basin, south india: Insights from human health risk and multivariate statistical techniques. Chemosphere, 185, 468-479.
Malakootian, M., Darabi Fard, Z., & Rahimi, M.(2015). Determination of radon concentration in drinking water resources of villages nearby lalehzar fault and evaluation the annual effective dose. J. Radioanal.Nucl.Chem, 304, 805-815.
Malakootian, M., Khashi, Z., Iranmanesh, F., & Rahimi, M.(2014a). Radon concentration in drinking water in villages nearby rafsanjan fault and evaluation the annual effective dose. J.Radioanal. Nucl Chem, 302, 1167-1176.
Malakootian, M., Khashi, Z., Iranmanesh, F., & Rahimi, M.(2014b). Radon concentration in drinking water in villages nearby rafsanjan fault and evaluation the annual effective dose. J.Radioanal.Nucl.Chem, 302 (3), 1167-1176.
Malakootian, M., Marvast, H.S., Negharestani, A., & Iranmanesh, F.(2016). Determination of radon concentration in drinking water of taft township and evaluation of the annual effective dose. Int.J.Radiat.Res, 14 (1), 39.
Malakootian, M., & Nejhad, Y.S.(2017). Determination of radon concentration in drinking water of bam villages and evaluation of the annual effective dose. Int.J.Radiat. Res, 15 (1), 81.
Malakootian, M., & Salmani, M.H.(2015). Determination of radon level in drinking water in mehriz villages and evaluation the annual effective absorbed dose. J. Community. Health. Res, 3 (4) ,253-260
Maleki, A., & Jari, H.(2021). Evaluation of drinking water quality and non-carcinogenic and carcinogenic risk assessment of heavy metals in rural areas of kurdistan, iran. Environ.Technol. Innov, 23, 101668.
Mamun, A., & Alazmi, A.S.(2022). Investigation of radon in groundwater and the corresponding human-health risk assessment in northeastern saudi arabia. Sustainability, 14 (21), 14515.
Messier, K.P., & Serre, M.L.(2017). Lung and stomach cancer associations with groundwater radon in north carolina, USA. Int.J.Epidemiol, 46 (2), 676-685.
Mirzabeygi, M., Yousefi, M., Soleimani, H., Mohammadi, A.A., Mahvi, A.H., & Abbasnia, A.(2018). The concentration data of fluoride and health risk assessment in drinking water in the ardakan city of yazd province, iran. Data in brief, 18, 40-46.
Moghaddam, V.K., Yousefi, M., Khosravi, A., Yaseri, M., Mahvi, A.H., Hadei, M., Mohammadi, A.A., Robati, Z., & Mokammel, A.(2018). High concentration of fluoride can be increased risk of abortion. Biol. Trace. Elem.Res, 185, 262-265.
Mohammadi, A., Faraji, M., Ebrahimi, A.A., Nemati, S., Abdolahnejad, A., & Miri, M.(2020). Comparing thms level in old and new water distribution systems; seasonal variation and probabilistic risk assessment. Ecotoxicol.Environ. Safe, 192, 110286.
Mohammadi, A.A., Yousefi, M., Yaseri, M., Jalilzadeh, M., & Mahvi, A.H.(2017). Skeletal fluorosis in relation to drinking water in rural areas of west azerbaijan, iran. Sci.Rep, 7 (1), 1-7.
Mohammadi, A.A., Zarei, A., Majidi, S., Ghaderpoury, A., Hashempour, Y., Saghi, M.H., Alinejad, A., Yousefi, M., Hosseingholizadeh, N., & Ghaderpoori, M.(2019). Carcinogenic and non-carcinogenic health risk assessment of heavy metals in drinking water of khorramabad, iran. MethodsX, 6, 1642-1651.
Mohammadi, B., Farajzadeh, M., & Safari, G.H.( 2021). The monitoring and health risk assessment of nitrate in drinking water in the rural and urban areas of tabriz, iran. J.Hum. Environ.Health. Promot, 7 (1), 15-21.
Mohammadpour, A., Gharehchahi, E., Badeenezhad, A., Parseh, I., Khaksefidi, R., Golaki, M., Dehbandi, R., Azhdarpoor, A., Derakhshan, Z., & Rodriguez-Chueca, J.(2022). Nitrate in groundwater resources of hormozgan province, southern iran: Concentration estimation, distribution and probabilistic health risk assessment using monte carlo simulation. Water, 14 (4), 564.
Mohammed Ali, N.S., Alalwan, H.A., Alminshid, A.H., & Mohammed, M.M.(2022). Synthesis and characterization of fe3o4-sio2 nanoparticles as adsorbent material for methyl blue dye removal from aqueous solutions. Pollution, 8 (1), 295-302.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & Group*, P.(2009). Preferred reporting items for systematic reviews and meta-analyses: The prisma statement. Ann.Intern.Med, 151 (4), 264-269.
Mosaferi, M., Asadi, M., Aslani, H., Mohammadi, A., Abedi, S., Nemati Mansour, S., & Maleki, S.(2021). Temporospatial variation and health risk assessment of trihalomethanes (thms) in drinking water (northwest iran). Environ.Sci.Pollut.Res, 28, 8168-8180.
Mousavi, S.M., Gouya, M.M., Ramazani, R., Davanlou, M., Hajsadeghi, N., & Seddighi, Z.(2009). Cancer incidence and mortality in iran. Ann. Oncol, 20 (3), 556-563.
Movafaghi Ardestani, M., & Pardakhti, A.(2020). Cancer and non-cancer risk assessment of heavy metals in ground gater resources of varamin plain. J.Environ.Stud, 46 (3), 379-390.
Mukate, S., Bhoominathan, S., & Solanky, V.(2022). Assessment of human health risk arising due to fluoride and nitrate in groundwater: A case study of bhokardan tehsil of maharashtra. Hum. Ecol.Risk. Assess,28(5-6), 1-27.
Nadali, A., Rahmani, A., Asgari, G., Leili, M., Norouzi, H.A., & Naghibi, A.(2019). The assessment of trihalomethanes concentrations in drinking water of hamadan and tuyserkan cities, western iran and its health risk on the exposed population. J.Res. Health .Sci, 19 (1), e00441.
Naddafi, K., Mesdaghinia, A., Abtahi, M., Hassanvand, M.S., Beiki, A., Shaghaghi, G., Shamsipour, M., Mohammadi, F., & Saeedi, R. (2022). Assessment of burden of disease induced by exposure to heavy metals through drinking water at national and subnational levels in iran, 2019. Environ.Res, 204, 112057.
Naderi, M., Jahanshahi, R., & Dehbandi, R. (2020). Two distinct mechanisms of fluoride enrichment and associated health risk in springs’ water near an inactive volcano, southeast iran. Ecotoxicol., 195, 110503.
Naji, N.B., Yas, R.M., Majeed, W.Z., Saeed, M.A., Hadi, R.W.A., & Al-Mashhadani, A.H. (2021). Radon concentrations assessment in tap water for different areas in baghdad city using rad7.AIP Conference ProceedingsAIP Publishing LLC,2372(1), 110006.
Niu, Z., Li, X., & Zhang, Y.(2017). Composition profiles, levels, distributions and ecological risk assessments of trihalomethanes in surface water from a typical estuary of bohai bay, china. Mar.Pollut. Bull, 117 (1-2), 124-130.
Pan, S., An, W., Li, H., Su, M., Zhang, J., & Yang, M.(2014). Cancer risk assessment on trihalomethanes and haloacetic acids in drinking water of china using disability-adjusted life years. J. Hazard. Mater, 280, 288-294.
Picetti, R., Deeney, M., Pastorino, S., Miller, M.R., Shah, A., Leon, D.A., Dangour, A.D., & Green, R. (2022). Nitrate and nitrite contamination in drinking water and cancer risk: A systematic review with meta-analysis. Environ.Res, 210, 112988.
Pirsaheb, M., Sharafi, K., Hemati, L., & Fazlzadehdavil, M. (2015). Radon measurement in drinking water and assessment of average annual effective dose in the west region of iran. Fresenius. Environ. Bull, 24 (10b), 3515-3519.
Qasemi, M., Afsharnia, M., Farhang, M., Bakhshizadeh, A., Allahdadi, M., & Zarei, A., (2018a). Health risk assessment of nitrate exposure in groundwater of rural areas of gonabad and bajestan, iran. Environ.Earth. Sci, 77, 1-9.
Qasemi, M., Afsharnia, M., Zarei, A., Farhang, M., & Allahdadi, M., (2018b). Non-carcinogenic risk assessment to human health due to intake of fluoride in the groundwater in rural areas of gonabad and bajestan, iran: A case study. Hum.Ecol.Risk. Assess,25(5),1222-1233.
Qasemi, M., Darvishian, M., Nadimi, H., Gholamzadeh, M., Afsharnia, M., Farhang, M., Allahdadi, M., Darvishian, M., & Zarei, A. (2023). Characteristics, water quality index and human health risk from nitrate and fluoride in kakhk city and its rural areas, iran. J.Food .Composit. Anal, 115, 104870.
Qasemi, M., Farhang, M., Biglari, H., Afsharnia, M., Ojrati, A., Khani, F., Samiee, M., & Zarei, A. (2018c). Health risk assessments due to nitrate levels in drinking water in villages of azadshahr, northeastern iran. Environ.Earth. Sci, 77 (23), 1-9.
Qasemi, M., Shams, M., Sajjadi, S.A., Farhang, M., Erfanpoor, S., Yousefi, M., Zarei, A., & Afsharnia, M., 2019. Cadmium in groundwater consumed in the rural areas of gonabad and bajestan, iran: Occurrence and health risk assessment. Biol.Trace. Elem. Res, 192, 106-115.
Qu, L., Huang, H., Xia, F., Liu, Y., Dahlgren, R.A., Zhang, M., & Mei, K. (2018). Risk analysis of heavy metal concentration in surface waters across the rural-urban interface of the wen-rui tang river, china. Environ.Pollut, 237, 639-649.
Radfard, M., Rahmatinia, M., Tabatabaee, H., Solimani, H., Mahvi, A.H., & Azhdarpoor, A. (2018a). Data on health risk assessment to the nitrate in drinking water of rural areas in the khash city, iran. Data in brief, 21, 1918-1923.
Radfard, M., Yunesian, M., Nabizadeh, R., Biglari, H., Nazmara, S., Hadi, M., Yousefi, N., Yousefi, M., Abbasnia, A., & Mahvi, A.H. (2018b). Drinking water quality and arsenic health risk assessment in sistan and baluchestan, southeastern province, iran. Hum. Ecol.Risk. Assess , 25(4), 949-965,
Radfard, M., Yunesian, M., Nabizadeh, R., Biglari, H., Nazmara, S., Hadi, M., Yousefi, N., Yousefi, M., Abbasnia, A., & Mahvi, A.H. (2019). Drinking water quality and arsenic health risk assessment in sistan and baluchestan, southeastern province, iran. Hum.Ecol.Rsk. Assess, 25 (4), 949-965.
Radfarda, M., Gholizadehc, A., Azhdarpoorb, A., Badeenezhada, A., Mohammadid, A.A., & Yousefie, M.( 2019). Health risk assessment to fluoride and nitrate in drinking water of rural residents living in the bardaskan city, arid region, southeastern iran. Water Treat, 145, 249-56.
Rahimi, M., Abadi, A.a.M., & Koopaei, L.J. (2022). Radon concentration in groundwater, its relation with geological structure and some physicochemical parameters of zarand in iran. Appl. Radiat. Isot, 185, 110223.
Rahman, M.M., Bodrud-Doza, M., Siddiqua, M.T., Zahid, A., & Islam, A.R.M.T. (2020). Spatiotemporal distribution of fluoride in drinking water and associated probabilistic human health risk appraisal in the coastal region, bangladesh. Sci.Total. Environ, 724, 138316.
Rao, N.S., Dinakar, A., & Kumari, B.K. (2021). Appraisal of vulnerable zones of non-cancer-causing health risks associated with exposure of nitrate and fluoride in groundwater from a rural part of india. Environ.Res, 202, 111674.
Rezaei, H., Jafari, A., Kamarehie, B., Fakhri, Y., Ghaderpoury, A., Karami, M.A., Ghaderpoori, M., Shams, M., Bidarpoor, F., & Salimi, M. (2019a). Health-risk assessment related to the fluoride, nitrate, and nitrite in the drinking water in the sanandaj, kurdistan county, iran. Hum. Ecol.Risk Assess:, 25 (5), 1242-1250.
Rezaei, H., Zarei, A., Kamarehie, B., Jafari, A., Fakhri, Y., Bidarpoor, F., Karami, M.A., Farhang, M., Ghaderpoori, M., & Sadeghi, H. (2019b). Levels, distributions and health risk assessment of lead, cadmium and arsenic found in drinking groundwater of dehgolan’s villages, iran. Toxicol.Environ.Health. Sci, 11, 54-62.
Rezvani Ghalhari, M., Ajami, B., Ghordouei Milan, E., Zeraatkar, A., & Mahvi, A.H. (2021). Assessment of non-carcinogenic health risk of nitrate of groundwater in kashan, central iran. Int.J.Environ.Anal.Chem, 1-13.
Sadeghi, H., Nasseri, S., Yunesian, M., Mahvi, A.H., Nabizadeh, R., & Alimohammadi, M. (2019). Trihalomethanes in urban drinking water: Measuring exposures and assessing carcinogenic risk. J. Environ.Health Sci.Eng, 17, 619-632.
Sadeghi, M., & Noroozi, M. (2021). Carcinogenic and non-carcinogenic risk assessment of heavy metals in water resources of north east of iran in 2018. J.Environ.Health.Sustain .Dev, 6 (2), 1321-1329.
Sajjadi, S.A., Mohammadi, A., Khosravi, R., & Zarei, A. (2022). Distribution, exposure, and human health risk analysis of heavy metals in drinking groundwater of ghayen county, iran. Geocarto Int, 1-18.
Saleh, H.N., Panahande, M., Yousefi, M., Asghari, F.B., Oliveri Conti, G., Talaee, E., & Mohammadi, A.A. ( 2019). Carcinogenic and non-carcinogenic risk assessment of heavy metals in groundwater wells in neyshabur plain, iran. Biol.Trace. Eelem. Res, 190, 251-261.
Shahriyari, J., Rezaei, M.R., Kamani, H., & Sayadi, A.M.H.(2020). Carcinogenic and non-carcinogenic risk assessment of heavy metals in drinking tap water in zabol city, iran. J Neyshabur Univ Med Sci 2020;8(3):59-75.
Shams, M., Tavakkoli Nezhad, N., Dehghan, A., Alidadi, H., Paydar, M., Mohammadi, A.A., & Zarei, A.
(2022). Heavy metals exposure, carcinogenic and non-carcinogenic human health risks assessment of groundwater around mines in joghatai, iran. Int.J.Environ. Anal.Chem, 102 (8), 1884-1899.
Sharma, S., Duggal, V., Srivastava, A., Mehra, R., & Rani, A. (2017). Radon concentration in groundwater and associated effective dose assessment in western haryana, india. Internat. J. Int. Res. Sci. Eng, 3, 69-78.
Shokoohi, R., Khazaei, M., Karami, M., Seid-Mohammadi, A., Khotanlou, H., Berijani, N., & Torkshavand, Z. (2021). Deterministic and probabilistic human health risk assessment approach of exposure to heavy metals in drinking water sources: A case study of a semi-arid region in the west of iran. J. Environ.Health Sci.Eng, 19 (1), 1047-1055.
Siddique, A., Saied, S., Mumtaz, M., Hussain, M.M., & Khwaja, H.A. (2015). Multipathways human health risk assessment of trihalomethane exposure through drinking water., 116, 129-136.
Soleimani, H., Azhdarpoor, A., Hashemi, H., Radfard, M., Nasri, O., Ghoochani, M., Azizi, H., Ebrahimzadeh, G., & Mahvi, A.H. (2022). Probabilistic and deterministic approaches to estimation of non-carcinogenic human health risk due to heavy metals in groundwater resources of torbat heydariyeh, southeastern of iran. Int.J.Environ.Anal.Chem, 102 (11), 2536-2550.
Solgi, E., & Jalili, M. (2021). Zoning and human health risk assessment of arsenic and nitrate contamination in groundwater of agricultural areas of the twenty two village with geostatistics (case study: Chahardoli plain of qorveh, kurdistan province, iran). Agric.Water .Manag, 255, 107023.
Sriboonnak, S., Induvesa, P., Wattanachira, S., Rakruam, P., Siyasukh, A., Pumas, C., Wongrueng, A., & Khan, E. (2021). Trihalomethanes in water supply system and water distribution networks. Int.J. Environ.Res. Public. Health, 18 (17), 9066.
Su, H., Kang, W., Li, Y., & Li, Z. ( 2021). Fluoride and nitrate contamination of groundwater in the loess plateau, china: Sources and related human health risks. Environ.Pollut, 286, 117287.
Suresh, S., Rangaswamy, D., Srinivasa, E., & Sannappa, J. (2020). Measurement of radon concentration in drinking water and natural radioactivity in soil and their radiological hazards. J.Radiat. Res. Appl. Sci, 13 (1), 12-26.
Tafesse, N., Porcelli, M., Gari, S.R., & Ambelu, A. (2022). Prevalence and trends of drinking water disinfection byproducts-related cancers in addis ababa, ethiopia. Environ.Health. Insights, 16, 11786302221112569.
Tokatlı, C., Islam, A.R.M.T., Onur, Ş.G., Ustaoğlu, F., Islam, M.S., & Dindar, M.B. (2022). A pioneering study on health risk assessment of fluoride in drinking water in thrace region of northwest türkiye. GroundW. Sustain.Dev, 19, 100836.
Ullah, Z., Rashid, A., Ghani, J., Nawab, J., Zeng, X.-C., Shah, M., Alrefaei, A.F., Kamel, M., Aleya, L., & Abdel-Daim, M.M. (2022). Groundwater contamination through potentially harmful metals and its implications in groundwater management. Front. Environ.Sci, 10, 2077.
Usepa, 2012. Edition of the drinking water standards and health advisories. Epa 822-s-12-001.
Varol, M., & Tokatlı, C. (2022). Seasonal variations of toxic metal (loid) s in groundwater collected from an intensive agricultural area in northwestern turkey and associated health risk assessment. Environ.Res, 204, 111922.
Villanueva, C.M., Fernandez, F., Malats, N., Grimalt, J.O., & Kogevinas, M. (2003). Meta-analysis of studies on individual consumption of chlorinated drinking water and bladder cancer. J.Epidemiol.Community. Health, 57 (3), 166-173.
Wagh, V.M., Panaskar, D.B., Mukate, S.V., Aamalawar, M.L., & Laxman Sahu, U. (2020). Nitrate associated health risks from groundwater of kadava river basin nashik, maharashtra, india. Hum.Ecol. Risk. Assess, 26 (3), 654-672.
Wang, Y., Zhu, G., & Engel, B. (2019). Health risk assessment of trihalomethanes in water treatment plants in jiangsu province, china., 170, 346-354.
Who, G. (2011). Guidelines for drinking-water quality. World health organization, 216, 303-304.
Yousefi, M., Asghari, F.B., Zuccarello, P., Oliveri Conti, G., Ejlali, A., Mohammadi, A.A., & Ferrante, M. ( 2019a). Spatial distribution variation and probabilistic risk assessment of exposure to fluoride in ground water supplies: A case study in an endemic fluorosis region of northwest iran. Int.J. Environ. Res.Public .Health, 16 (4), 564.
Yousefi, M., Ghalehaskar, S., Asghari, F.B., Ghaderpoury, A., Dehghani, M.H., Ghaderpoori, M., & Mohammadi, A.A. (2019b). Distribution of fluoride contamination in drinking water resources and health risk assessment using geographic information system, northwest iran. Regul. Toxicol.Pharmacol, 107, 104408.
Yousefi, M., Ghoochani, M., & Mahvi, A.H. (2018a). Health risk assessment to fluoride in drinking water of rural residents living in the poldasht city, northwest of iran., 148, 426-430.
Yousefi, M., Mohammadi, A.A., Yaseri, M., & Mahvi, A.H. (2017). Epidemiology of drinking water fluoride and its contribution to fertility, infertility, and abortion: An ecological study in west azerbaijan province, poldasht county, iran. Fluoride, 50 (3), 343-353.
Yousefi, M., Yaseri, M., Nabizadeh, R., Hooshmand, E., Jalilzadeh, M., Mahvi, A.H., & Mohammadi, A.A.( 2018b). Association of hypertension, body mass index, and waist circumference with fluoride intake; water drinking in residents of fluoride endemic areas, iran. Biol.Trace Elem.Res, 185, 282-288.
Yu, G., Wang, J., Liu, L., Li, Y., Zhang, Y., & Wang, S. (2020). The analysis of groundwater nitrate pollution and health risk assessment in rural areas of yantai, china. BMC Public Health, 20 (1), 1-6.
Zendehbad, M., Mostaghelchi, M., Mojganfar, M., Cepuder, P., & Loiskandl, W.(2022). Nitrate in groundwater and agricultural products: Intake and risk assessment in northeastern iran. Environ. Sci.Pollut. Res, 29 (52), 78603-78619.