Assessing risk perception and knowledge gaps of tick-borne diseases in Nei Mongol Zizhiqu and Northeast China

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: < 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.