Abstract River regulations and changing land management practices are generally perceived to be the dominant drivers of river flood changes in countries with rapid economic growth, such as China. Here, we demonstrate based on the most comprehensive flood database to date, that climate variations dominate the spatial pattern of changes in annual flood peak discharge in China, despite intense human alterations of the river and land systems over the past four decades. Regional flood increases are mainly associated with increasing precipitation due to changes in the East Asian Summer Monsoon, tropical cyclones and the subtropical westerly jet. Regional flood decreases are due to decreased soil moisture in the North China plain. Our results highlight the need for flood management policies to go beyond local measures and adapt to the effects of climate change.