Fluoride enrichment in deep groundwater systems poses critical environmental and public health challenges. In this study, 106 deep groundwater samples from the Bozhou Plain (BZP) were systematically analyzed using hydrogeochemical approaches and probabilistic risk modeling to identify fluoride sources, elucidate geochemical dynamics, and assess health risks. The results demonstrated that the groundwater exhibited weak alkalinity and moderate mineralization. Hydrochemical facies were dominated by Cl·HCO3–Na and HCO3–Na. Fluoride concentrations varied between 0.5 and 5.9 mg L−1(mean: 1.9 mg L−1), with 87.7 % of samples exceeding the Chinese National Drinking Water Standards. Geochemical evidence from Piper diagrams, Gibbs plots, and saturation indices indicated that fluorite dissolution was the principal source of F−, while calcite precipitation and cation exchange reduced Ca2+ activity, thereby enhancing fluoride accumulation. Health risk assessment using Monte Carlo simulations revealed that the mean hazard index for children was 1.57, significantly higher than 0.91 for adults. The probability of non-carcinogenic risk reached 75.71 % for children, compared to 36.22 % for adults. These findings quantitatively clarify the mechanisms of fluoride enrichment in confined aquifers and highlight the elevated vulnerability of children, providing essential insights for groundwater safety management in fluoride-affected regions.
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