[Objective] Groundwater, as a vital component of water resources, objectively reveals the sources of heavy metal contamination and associated health risks. This information holds significant importance for the rational utilization and effective management of groundwater in agricultural areas. [Methods] Using 119 representative sampling sites in eastern Henan Province, this study selected 10 heavy metals (Zn, Pb, Cr, As, Cu, Fe, Mn, Al, Hg, and Ni) were analyzed at 119 representative sampling sites in eastern Henan Province. By integrating single-factor pollution indices, the Nemero composite index, absolute factor analysis-multivariate linear regression (APCS-MLR), and health risk assessment models, this study examined groundwater heavy metal content characteristics, spatial distribution, and pollution status to identify pollution sources and evaluate health risks. [Results] ①The average concentrations of groundwater heavy metals in eastern Henan Province, ranked from highest to lowest, were Mn > Zn > Al > Fe > Cu > As > Ni > Pb > Cr > Hg. The average Mn concentration exceeded the Class III standard limit specified in the “Groundwater Quality Standard (GB/T 14848-2017)”, while concentrations of As, Pb, and Ni at some sampling points exceeded the national Class III standard limits. ②Regarding single-factor pollution levels for each heavy metal in Eastern Henan, Mn exhibited severe pollution while all others remained clean. The proportions of sampling points showing mild and severe pollution were 36.13% and 31.09%, respectively. Mn was identified as the dominant factor in groundwater heavy metal pollution. ③The average contribution rates of industrial sources, unknown sources, agricultural sources, natural sources, and traffic sources decrease in that order, accounting for 41.44%, 20.81%, 18.72%, 12.57%, and 6.46%, respectively. However, the contributions of different sources to various heavy metals exhibit significant variability. ④Under drinking water intake and dermal contact pathways, the health risks posed by non-carcinogenic and carcinogenic elements to both adults and children remain within acceptable limits. [Conclusion] The heavy metal content in groundwater in the eastern Henan region exhibits variability, posing risks to human health within acceptable limits. However, targeted measures should be implemented based on the pollution status and sources of individual elements to enhance groundwater heavy metal utilization and management, while dynamically monitoring their health risk status.