Concentration of fluoride in groundwater of India: A systematic review, meta-analysis and risk assessment

It is a well-known fact that the Indian groundwater is polluted by fluoride. However, for the first time in India, non-carcinogenic risk assessments and meta-analysis of fluoride exposure to humans were carried out due to consumption of groundwater. In this context, we collected fluoride concentration data in groundwater across India by systematic searches conducted in various international search engines databases. Here, we demonstrated a detailed meta-analysis and meta-regression of fluoride and evaluated health risk assessment. For this purpose, meta-analysis of 63 studies on fluoride in groundwater in India, comprising 57381 samples are included. We found that 1.) The pooled concentration of fluoride in India is around 2.37 mg/L with 95% confident interval (1.46-3.28 mg/L) which is higher than WHO and national standards limit of 1.5 mg/L. 2) The meta-analysis of data suggests that in rural parts of the country, fluoride concentration is 1.85 times higher than urban areas. 3) The concentration of fluoride in groundwater decreased significantly (p < 0.05) with increase in rainfall and longitude. The risk assessment via oral and dermal route exposure reveals that the consumers in majority of the regions are at considerable non-carcinogenic risk and children are at higher risk than adults (Total hazard quotient > 1). The findings are helpful in identifying the affected areas of India and we recommend that the safer options of drinking water should be adopted.