Assessment of burden of disease induced by exposure to heavy metals through drinking water at national and subnational levels in Iran, 2019.

The burden of disease attributable to exposure to heavy metals via drinking water in Iran (2019) was assessed at the national and regional levels. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease of heavy metals in drinking water were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), and nickel (Ni) in Iran were determined to be 2.3, 0.4, 12.1, 2.5, 0.7, and 19.7 μg/L, respectively, which were much lower than the standard values. The total average HQs of heavy metals in drinking water in the entire country, rural, and urban communities were 0.48, 0.65 and 0.45, respectively. At the national level, the average ILCRs of heavy metal in the entire country were in the following order: 1.06 × 10 for As, 5.89 × 10 for Cd, 2.05 × 10 for Cr, and 3.76 × 10 for Pb. The cancer cases, deaths, death rate (per 100,000 people), DALYs, and DALY rate (per 100,000 people) attributed to exposure to heavy metals in drinking water at the national level were estimated to be 213 (95% uncertainty interval: 180 to 254), 87 (73-104), 0.11 (0.09-0.13), 4642 (3793-5489), and 5.81 (4.75-6.87), respectively. The contributions of exposure to As, Cd, Cr, and Pb in the attributable burden of disease were 14.7%, 65.7%, 19.3%, and 0.2%, respectively. The regional distribution of the total attributable DALY rate for all heavy metals was as follows: Region 5> Region 4> Region 1> Region 3> Region 2. The investigation and improvement of relatively high exceedance of As levels in drinking water from the standard value, especially in Regions 5 and 3 as well as biomonitoring of heavy metals throughout the country were recommended.