Assessing drinking water quality based on water quality indices, human health risk, and burden of disease attributable to heavy metals in rural communities of Yazd County, Iran, 2015-2021.

The water quality indices, health risk, and burden of disease attributable to heavy metals in rural communities of Yazd County, Iran during 2015-2021 were studied. The drinking water quality index (DWQI) based on 27 parameters (including heavy metals) and heavy metal pollution index (HPI) were used for assessing drinking water quality. The health risk and burden of disease from heavy metals in drinking water were estimated in terms of hazard quotient (HQ), hazard index (HI), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY). Based on the DWQI scores by community, the drinking water quality in rural communities of Yazd County was characterized as good for 61 %, fair for 25 %, marginal for 2 %, and poor for 12 %. The distribution of the rural communities into the HPI categories was as follows: 43 % for excellent, 36 % for good, 14 % for poor, and 7 % for unsuitable. In about 20 % of the rural communities, the average HI level of heavy metals was higher than the boundary limit of one. The highest average HQ level at the county level was related to arsenic (As) to be 0.44. In all the communities, the total ILCR values of the heavy metals were in the category of significant increased cancer risk (10 to 10). At the county level, As and cadmium (Cd) exhibited the two highest cancer risk levels to be 1.96 × 10 and 1.87 × 10 for ILCR, respectively. The DALY rate (per 100,000 people) induced by exposure to the heavy metals via drinking water was 13.9, which was considered relatively high as compared to that of other drinking water pollutants obtained in the previous studies. The drinking water quality improvement through decreasing Cd and As levels below the standard values can drastically reduce the attributable burden of disease and promote the public health in the rural communities.