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Understanding the formation of high fluoride (F - ) groundwater in water-scarce northern China is critical for the sustainable development of the region. This study investigates the effects of F - enrichment in groundwater from seven typical regions of northern China, including Datong, Guide, Junggar, Yinchuan, Taiyuan, and Tarim basins and the North China Plain. A literature survey of 534 samples of selected regions showed that 45.13% of groundwater F - exceeded the 1.0 mg/L of Chinese drinking water guideline. Based on the geological background and hydrogeochemical analysis, in Datong and Yinchuan basins and part of the North China Plain, the main types of groundwater are soda water and controlling processes of F - enrichment are salinization, mineral dissolution, and desorption. In Taiyuan and Guide basins with Cl-Na water type, F - enrichment is mainly affected by salinization, cation exchange, and evaporation. The hydrogeochemical characteristics of high F - groundwater in Tarim and Junggar basins reflect the extent of salinization and weathering dissolution of minerals in groundwater. According to PCA, the contribution of salinization and mineral dissolution to F - enrichment is relatively high. Under the alkaline condition, groundwater with high Cl - , HCO 3 - , and Na + concentration favors F - enrichment. Based on HCA, index clustering category I explains the influence of pH and buried depth on F - enrichment, and category II explains the effect of different ions. It is concluded that F - enrichment in groundwater is related to hydrogeochemical processes and hydrogeological conditions. The hydrogeochemical and alkaline conditions of groundwater are regulated by mineral dissolution, ion exchange, and evaporation, resulting in different degrees of F - enrichment.