Epidemiology and spatiotemporal patterns of human echinococcosis in China, 2006-2020

China accounts for over 90% of global alveolar echinococcosis (AE) cases caused primarily by Echinococcus multilocularis. If left untreated, AE can have a 10-year mortality rate of 94%. Understanding its epidemiological patterns is essential for targeted control strategies. Surveillance data from 2006 to 2020 were obtained from the Public Health Scientific Data Center, and spatial and temporal trends were analyzed using spatial autocorrelation, hot spot analysis, and centroid migration techniques. A total of 51,403 echinococcosis cases were reported from 2006 to 2020, with an average annual incidence of 0.25 per 100,000. Most cases (71.33%) occurred in individuals aged 20-60 years. High-incidence areas centred in western/northwestern provinces, including Qinghai, Xinjiang, Xizang, Gansu, and Ningxia. Incidence and cases increased until 2017, then declined steadily. Spatial autocorrelation revealed persistent High-High clusters in Gansu and Ningxia (2008-2018) and Xizang (2010-2020), while Low-Low clusters persisted in central/eastern China. Hotspot analysis confirmed sustained high-risk zones in western/northwestern regions. Trend surface and centroid migration showed a southward disease shift within Qinghai. Echinococcosis remains endemic in western/northwestern China, with a trend of southward expansion. Strengthened, tailored interventions are urgently needed, particularly in high-burden areas like Xizang and Qinghai.