Abstract: Objective To investigate the epidemic trends, key populations, and high-risk regional characteristics of hand-footmouth disease (HFMD) in Ningbo from 2018 to 2023, and to provide evidence-based references for optimizing prevention strategies and precise allocation of prevention and control resources. Methods Data on HFMD cases with current addresses in Ningbo from 2018 to 2023 were collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological methods were used to analyze the epidemiological characteristics of HFMD. Global spatial autocorrelation analyses were applied to detect spatial clustering, and spatiotemporal scan analyses were conducted to identify spatiotemporal clusters. Results A total of 116 967 HFMD cases, including 2 severe cases and no fatal cases, in Ningbo Cityfrom 2018 to 2023were included.. The average annual incidence rate was 206.33 per 100 000 population, showing an overall declining trend. Seasonal patterns were observed, with bimodal distributions in 2018, 2019, 2021, and 2022 (main peak: May–July; secondary peak: September–November), and unimodal distributions in 2020 (October–December) and 2023 (July–October). Children aged 5 years old and under accounted for the majority of cases (104 634 cases, 89.46%), with a mean age of onset of 3.48±3.29 years. The maleto-female ratio was 1.44:1. Children cared for at home (56.39%) and those attending kindergarten (35.97%) were the predominant populations. Regionally, the highest incidence was in southern Ninghai County (261.46/100 000), followed by central areas, while northern Cixi City had the lowest incidence(194.89/100 000). The highest incidence rate was observed in areas classified as urbanrural fringes (240.08 per 100,000).Spatial analyses revealed global clustering in 2020 (Moran's I=0.35, P<0.05), with hotspots concentrated in Ninghai and Xiangshan counties. Spatiotemporal scan analyses identified significant clusters each year from 2018 to 2023. The strongest clustering was in Cixi City from May to September in 2018 (LLR=27 249.53, RR=13.06, P<0.01), followed by Yinzhou District from April to October in 2019 (LLR=25 172.16, RR=10.61, P<0.01). Conclusion The overall incidence of HFMD in Ningbo City showed a declining trend, with a bimodal spring-summer and autumn-winter ora unimodal autumn-winter seasonal patterns. The disease predominantly affected male children aged 5 years old and under who were cared for at home or attended kindergarten, with high-risk areas concentrated in southern counties (Ninghai and Xiangshan). It is recommended to strengthen health education and vaccination coverage for children aged 5 years old and under, while implementing dynamic surveillance and targeted interventions in key areas during high-incidence seasons to reduce transmission and prevalence.