Water levels in deltas and estuaries vary on multiple timescales due to coastal, hydrologic, meteorologic, geologic, and anthropogenic factors. These diverse factors increase the uncertainty of, and may bias, relative sea level rise (RSLR) estimates. Here, we evaluate RSLR in San Francisco Bay and the Sacramento-San Joaquin Delta, USA by applying a physics-based, nonlinear regression to 50 tide gauges that determines the spatially varying controls on daily mean water level for water years 2004–2022. Results show that elevated river flow and pumping (99th percentile) raise water level up to 6 m and lower it up to 0.35 m, respectively, and coastal water level variations are attenuated by 30-60% within the Delta. Strong westerly winds raise water level up to 0.17 m, and tidal-fluvial interaction during spring tides and low discharge raises water level up to 0.15 m. Removal of these interfering factors greatly improves RSLR estimates, narrowing 95% confidence intervals by 89–99% and removing bias due to recent drought. Results show that RSLR is spatially heterogeneous, with rates ranging from − 2.8 to 12.9 mm y-1 (95% uncertainties < 1 mm y-1). RSLR also exceeds coastal SLR of 3.3 mm y-1 in San Francisco at 85% of stations. Thus, RSLR in the Delta is strongly influenced by local vertical land motion and will likely produce significantly different, location-dependent future flood risk trajectories.