As a typical high geological background area in the middle reaches of the Yangtze River tributary basin in China, the Loushao Basin in Hunan is covered with high mineral black shale, with an average element value 4.76–8.97 times higher than the world average rock level. The aim of this study is to analyze the water environment pollution in the middle reaches of the Yangtze River tributary basin under high geological background based on the spatial distribution differences of black shale concentration. PCA source analysis is used to track the source of pollution and highlight the differences in body shape to assess regional health risks. The research results show that Cd in water quality exceeds the background value by 7.5 times. There is a strong homology among Pb, Cd, Cr, As, and Hg elements in water bodies, mainly derived from the natural weathering, migration, and enrichment of rocks. Hg element is a pollution caused by human factors, and water pollution is more severe in areas close to high concentrations, with severe exceedance of Cr element in water quality. The main controlling factor for individual health risk differences is body shape, and men's health is more susceptible to threats.
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