- A groundwater arsenic-fluoride concentration map highlights enrichment zones.
- Volcanic glass is likely a primary source of arsenic-fluoride contaminated water.
- Evaporation in (semi)arid areas concentrates arsenic-fluoride in aquifers
- The states of Durango, San Luis Potosí, and Zacatecas have higher exposure risk
Arsenic and fluoride in drinking water present a significant challenge to public health worldwide. In this study, we analyze the results of one of the largest surveys of drinking water quality in Mexico: 14,058 samples from 3951 sites, collected between January and December 2017. We use these data to identify the distribution and possible origin of arsenic and fluoride in drinking water throughout the country, and to estimate the associated health burden. The highest concentrations appear in alluvial aquifers in arid northern Mexico, where high-silica volcanic rock likely releases both arsenic and fluoride to the groundwater. We find fluoride contamination to be significantly correlated with aridity (Pearson correlation?=??0.45, p?=?0.0105), and also find a significant difference in fluoride concentrations between arid and humid states (Welch’s t-test, p?=?0.004). We estimate population exposure by assigning to each town in Mexico the average concentration of any sampling sites within 5?km. Our results show that 56% of the Mexican population lives within 5?km of a sampling site, 3.05 million people are exposed to fluoride above the reference dosage of 0.06?mg/(kg???day), 8.81 million people are exposed to arsenic above the limit of 10??g/L, and an additional 13,070 lifetime cases of cancer are expected from this arsenic exposure alone. This burden of disease is concentrated in the arid states of north-central Mexico.