The first national-scale assessment of lead (Pb) contamination in agricultural soils across China was conducted based on >1900 articles published between 1979 and 2016. Pb concentrations, temporal and spatial variations, and influencing factors were analyzed. Children's blood lead levels (BLLs) were also estimated using the integrated exposure uptake biokinetic (IEUBK) model. Pb concentrations in different areas of China varied greatly, which was closely associated with the distribution of Pb-related industries, especially Pb-zinc mine smelting, non-ferrous polymetallic mine smelting, e-waste recycling, and leaded gasoline consumption. The year 2000 was a significant transition year for Pb concentrations, with a rapid increase pre-2000 and a subsequent slow upward trend. Pb concentrations were found to be strongly associated with indicators of economic and social development including gross domestic product (GDP), population size, and vehicle ownership. Leaded gasoline, coal combustion, and non-ferrous smelting were the main sources of atmospheric Pb during the different periods. Predicted BLLs were higher in South China than those in the north. This study details the overall Pb contamination status of agricultural soils in China, and thus provides insights for policymakers with respect to pollution prevention measures.