Abstract: Objective To analyze the long-term epidemiological trends, population distribution characteristics, and changes in the spectrum of pesticide poisoning in Yuyao City, Zhejiang Province, from 2010 to 2024, and to provide evidence for formulating precise prevention and control strategies. Methods Case report data on pesticide poisoning were collected from the Occupational Disease and Occupational Health Information System of the Chinese Center for Disease Control and Prevention. Based on the definitions, poisonings occurring during pesticide production, transportation, sales, or use due to improper protection or accidents were categorized as occupational poisoning, further subdivided into occupational self-use (poisoning occurring while working on one's own farmland) and occupational hired work (poisoning occurring while being employed by others for pesticide-related tasks). Pesticide poisonings occurring outside occupational activities were categorized as non-occupational poisoning, further subdivided into non-occupational intentional ingestion (poisoning resulting from clear suicidal or self-harming intent) and non-occupational accidental ingestion (poisoning caused by unintentional intake or contact). Descriptive epidemiological methods and the Joinpoint regression model were used for statistical analysis. Results Over the 15-year period, 794 cases of pesticide poisoning were reported in Yuyao City, with an average annual incidence rate of 4.78 /10⁵. There were 45 deaths, resulting in an overall case fatality rate of 5.67%. Non-occupational poisoning was predominant (85.64%), with both its incidence rate (4.09/105) and case fatality rate (6.62%) being significantly higher than those of occupational poisoning (0.69/10⁵， 0.00%) (all P < 0.05). Regarding temporal trends, the overall incidence rate showed a significant decline from 2010 to 2019 (APC = -8.136%, P < 0.05), then stabilized; the overall case fatality rate showed a declining trend (AAPC = -6.775%, P < 0.05). Monthly distribution indicated that occupational poisoning mainly occurred in August and September, accounting for 46.49% of annual cases; non-occupational poisoning was concentrated in May, June, and July, accounting for 36.03%. In terms of population distribution, occupational poisoning was most common in the 65-74 age group (30.70%); non-occupational poisoning was most common in the 55-64 age group (28.97%), and this age group also accounted for 34.54% of all intentional ingestion cases. The overall incidence rate was higher in males than in females (χ²=16.813, P < 0.001). The top three pesticides causing occupational poisoning were dichlorvos (37.72%), methamidophos (8.77%), and paraquat (5.26%). The top three pesticides causing non-occupational poisoning were dichlorvos (26.62%), paraquat (7.94%), and methamidophos (5.74%). For both intentional and accidental ingestion within non-occupational poisoning, the top three pesticides were consistently dichlorvos, paraquat, and methamidophos. Over the 15 years, the number of non-occupational poisoning cases caused by dichlorvos showed no significant trend (AAPC=-2.752%, P=0.242), while cases caused by methamidophos and paraquat significantly decreased (AAPC=-19.024%, P < 0.001; AAPC=-9.930%, P=0.018). Conclusion From 2010 to 2024, pesticide poisoning in Yuyao City was predominantly driven by non-occupational poisoning, with intentional ingestion among middle-aged and elderly groups being the key focus for prevention and control. Dichlorvos remains a persistent major risk pesticide. Future prevention and control efforts require comprehensive strategies, focusing on strengthening the regulation of high-risk pesticide circulation and constructing a multi-dimensional prevention and control system integrating mental health interventions and targeted health education.