Background

Ticks are key vectors of zoonotic diseases in the Northern Hemisphere, including China, yet surveillance and public awareness remain limited. While global studies address risk perception, similar research in China, especially with spatial or longitudinal detail, is scarce. This study assesses tick-borne disease risk perception, influencing factors, and spatial variation in Northeast China and Nei Mongol Zizhiqu (also known as Inner Mongolia Autonomous Region) to inform targeted interventions.

Methods

In 2019, a cross-sectional questionnaire surveyed 4000 adults in Heilongjiang, Jilin, Liaoning, and Nei Mongol Zizhiqu using multi-stage sampling. Knowledge was assessed in four domains: tick biology/ecology, bite treatment, tick-borne diseases, and bite prevention, alongside socio-demographic and behavioral data. Descriptive statistics and multiple logistic regression identified knowledge levels and associated factors.

Results

Knowledge of tick biology was relatively high (1830/4000, 45.8% with high knowledge), but awareness of bite treatment, diseases, and especially prevention was low (31.5% with high tick-borne disease knowledge; 21.6% with high prevention knowledge), even among high-risk groups. Urban residents had higher knowledge than those in rural or remote areas. Frequent woodland visits and prior tick bites increased knowledge of tick biology (regression coefficients: 0.311 and 0.387, both P < 0.001) but not prevention. Education and outdoor activity showed mixed associations with knowledge domains.

Conclusion

Major gaps exist in public knowledge of tick-borne diseases, particularly regarding prevention, with notable disparities across regions and risk groups. Targeted, region-specific interventions are urgently needed to improve awareness and protection, especially in high-risk and low-awareness areas.

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