National Administration of Surveying, Mapping and Geoinformation of China performed the first order leveling campaign for the second time from 1991 to 1999 and the latest leveling campaign from 2012 to 2015, respectively. The time span of two leveling campaigns was about 20 years, due to the influence of crustal movement, economic construction, groundwater exploitation and recharge, the ground surface settlement with different degree and seasonal surface relieves occurred in some regions, which led to various changes of regional elevation and affected the maintenance of height datum and the application of elevation results. The first order leveling coincidence points in the two periods and their changes and trends were analyzed. The reasons for the change of elevation were analyzed from four aspects, which are the difference of measuring equipment, measures and measuring accuracy of leveling network in two periods, the difference of gravity datum, normal gravity formula and gravity data adopted by correcting computation of gravity anomaly, the difference of configuration structure, the difference of leveling period and closure period of leveling ring as well as the influence of vertical crustal movement and local surface deformation. Through this analysis, we can conclude that the serious ground surface settlement occurred in some regions during the recent 20 years. The vertical crustal movement and local surface deformation are the major factors affecting the elevation changes. The first order leveling should be monitored on a regular period which should be no more than 5 years and strives for 3 years.