<p>The Luanhe River Piedmont Alluvial Fan Complex, a critical industrial-agricultural zone in North China, faces severe groundwater contamination from anthropogenic sources. Hence, forty groundwater samples collected were analyzed by employing multivariate statistics, Piper trilinear diagram, Gibbs diagrams, and ion ratios. Additionally, principal component analysis (PCA) was used to identify the principal factors influencing groundwater, and health risk assessment (HRA) was conducted for nitrate (NO₃⁻) and fluoride (F⁻). The results revealed that the groundwater is generally weakly alkaline (mean pH = 7.52) and primarily classified as the HCO₃–Ca·Mg type (72% of samples). Among major ions, Ca²⁺ was the dominant cation (all samples), and HCO₃⁻ the dominant anion (75% of samples). Naturally, the hydrochemistry of groundwater is predominantly controlled by water–rock interaction, including carbonate dissolution and cation exchange. Anthropogenically, industrial and mining activities are the primary factors controlling this hydrochemistry, with agricultural activities being a key contributor to NO₃⁻. Critically, the PCA extracted two principal components representing pollution (70.2% variance explained) and salinization (19.8% variance explained) factors. The HRA results demonstrated that NO₃⁻ poses a significant non-carcinogenic risk to local residents. In particular, infants were the most vulnerable group, with 15% of samples showing HQ ≥ 1, compared to 10% in children and 5% in adults. In contrast, the health risk from F⁻ was within acceptable limits (HQ &lt; 1). Overall, these findings provide a critical scientific basis for the sustainable management and protection of groundwater resources in the similar Piedmont Alluvial Fan Complex.</p>