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Heavy metals (HMs) in drinking water have drawn worldwide attention due to their risks to public health; however, a systematic assessment of the occurrence of HMs in drinking water treatment plants (DWTPs) at a large geographical scale across China and the removal efficiency, human health risks, and the correlation with environmental factors have yet to be established. Therefore, this study characterised the occurrence patterns of nine conventional dissolved HMs in the influent and effluent water samples from 146 typical DWTPs in seven major river basins across China (which consist of the Yangtze River, the Yellow River, the Songhua River, the Pearl River, the Huaihe River, the Liaohe River and the Haihe River) for the first time and removal efficiency, probabilistic health risks, and the correlation with water quality. According to the findings, a total of eight HMs (beryllium (Be), antimony (Sb), barium (Ba), molybdenum (Mo), nickel (Ni), vanadium (V), cobalt (Co) and titanium (Ti)) were detected, with detection frequencies in influent and effluent water ranging from 2.90 (Mo) to 99.30% (Ba) and 1.40 (Ti) to 97.90% (Ba), respectively. The average concentration range was 0.41 (Be)− 77.36 (Sb) μg/L. Among them, Sb (exceeding standard rate 8%), Ba (2.89%), Ni (21.43%), and V (1.33%) were exceeded the national standard (GB5749–2022). By combining Spearman's results and redundancy analysis, our results revealed a close correlation among pH, turbidity (TURB), potassium permanganate index (COD Mn), and total nitrogen (TN) along with the concentration and composition of HMs. In addition, the concentration of HMs in finished water was strongly affected by the concentration of HMs in raw water, as evidenced by the fact that HMs in surface water poses a risk to the quality of finished water. Metal concentration was the primary factor in assessing the health risk of a single metal, and the carcinogenic risk of Ba, Mo, Ni, and Sb should be paid attention to. In DWTPs, the removal efficiencies of various HMs also vary greatly, with an average removal rate ranging from 16.30% to 95.64%. In summary, our findings provide insights into the water quality and health risks caused by HMs in drinking water. [Display omitted] • First study to assess nine heavy metals in 146 DWTPs across China. • High levels of Ba, Ni, Sb, and V were exceeded the guideline recommended by the China. • Strong correlations exist between the pH, turbidity, COD Mn, TN and heavy metals. • The health risk of Ba, Mo, Ni, and Sb should be concerned. • The mean removal ratios of heavy metals in the studied DWTPs were 16.30–95.64%. [ABSTRACT FROM AUTHOR]