<p>With rapid urbanization in China and evolving residents’ lifestyles, indoor air quality (IAQ) has become a growing concern across various sectors of society. Among indoor pollutants, volatile organic compounds (VOCs) are ubiquitous contaminants with varied and complex sources, posing potential health risks that represent a pressing public health issue. This study aims to provide a systematic critical review of VOC exposure characteristics in China-specific indoor environments, evaluate their health risks through comparative analysis, and develop evidence-based control strategies.&#xa0;This study conducts a systematic review following PRISMA guidelines of peer-reviewed literature on indoor VOCs in China published between 2000 and 2024. We searched Web of Science, PubMed, CNKI, Wanfang, and VIP databases, ultimately including 246 studies meeting quality criteria. VOC concentration data from various indoor environments including residences, public spaces, and vehicles were systematically analyzed using meta-analytical techniques. Health risk assessments were synthesized using EPA-established methodologies adapted with China-specific exposure factors, focusing on both carcinogenic and non-carcinogenic risks. The analysis examined unique contributions of China-specific factors including building materials, household products, Chinese-style cooking, and human activities to indoor VOC emissions through an analytical framework linking sources, pathways, and receptors.&#xa0;The review reveals significant spatiotemporal heterogeneity in VOC concentrations within Chinese indoor environments, with substantial methodological considerations affecting reported values. Formaldehyde, benzene homologues, and TVOCs frequently exceed national standards, with exceedance rates reaching 88.29–96.43% in some residential areas. Meta-analysis shows formaldehyde concentrations demonstrate temperature-dependent emission following modified Arrhenius kinetics (activation energy = 45.2 ± 3.8&#xa0;kJ/mol), with summer levels 2.3 times higher than winter. Regional analysis reveals BTX concentrations in northeastern China exceed southern regions by 2–3 fold, correlating with heating degree days (<i>r</i> = 0.76) and economic development indices (<i>r</i> = 0.68). Health risk assessments indicate lifetime cancer risks exceed acceptable thresholds by 10–100 fold even at concentrations meeting national standards. Children show elevated vulnerability with adjusted odds ratios for asthma of 11.985 for formaldehyde exposure, substantially higher than Western populations. Occupational groups face extreme exposures, with renovation workers’ cumulative cancer risk reaching 1.2 × 10^− 4. Mixture effects analysis reveals synergistic interactions increasing hazard indices by 40–90% above additive models.&#xa0;Indoor VOC pollution in China presents unique public health challenges requiring targeted interventions beyond Western models. The fundamental disconnect between regulatory compliance and health protection stems from standards based on odor thresholds rather than health endpoints, unique emission sources from rapid urbanization, and synergistic effects of complex mixtures. The study proposes an integrated control framework prioritizing source management (benefit-cost ratio = 4.0), ventilation optimization accounting for outdoor pollution trade-offs, advanced purification technologies, culturally-sensitive behavioral interventions, and tiered regulatory standards recognizing population vulnerability. Implementation requires coordinated multi-stakeholder engagement and recognition of China-specific exposure scenarios. Future research priorities include establishing long-term monitoring networks, assessing emerging VOCs, and developing cost-effective technologies adapted to Chinese conditions.</p>