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China is facing a groundwater depletion and deterioration crisis, culminating from long-term over-exploitation and groundwater contamination. Aggravating factors include population growth, unprecedented urbanization and climate change. Sustainable groundwater management is called for, however, a valid means for a national-scale assessment of groundwater resource sustainability does not currently exist. Here we present a drivers-pressures-states-impact-response (DPSIR) assessment framework. Based on this framework, groundwater sustainability indices for mainland China's 31 provinces and municipalities were derived, with an average score of 595 out of 100, ranging from 47.3 for Tianjin to 72.9 for Tibet. We found that due to fewer Drivers and better States, groundwater resources in southern China are far more sustainable than those in the northern and eastern areas. An appraisal of subcategories shed light on the importance of affording attention to externalities such as societal, economic and environmental factors, which are interrelated as complex systems. Based on the assessment findings, implications for policy and decision-making suggestions for sustainable management of China's groundwater resources are put forward. (C) 2019 Elsevier B.V. All rights reserved.