Sinkholes are a major geohazard in cities in karst area in China. Out of the 337 prefecture level and provincial capital cities in China, 113 are located in high-risk areas of sinkhole. Addressing this hazard has the highest priority in urban construction and development in these cities. This article introduces the main achievements made by the author’s research team in recent years with the support of the China Geological Survey in which over 3,900 sinkholes were documented and studied in detail. The survey results show that approximately 76% of urban sinkholes in China are related to engineering activities including foundation pit construction, pile foundation construction, and subway tunnel construction. Furthermore, the monitoring results indicated that the rapid decrease or significant fluctuation of groundwater pressure in karst conduit systems are the primary reason causing sinkhole formation during construction. Based on these findings, we propose a technical approach for effectively reducing and preventing the risk of sinkhole based on high-frequency groundwater monitoring and optimizing engineering construction plans and processes.