This study collected data on paragonimiasis cases from 13 medical institutions in Chongqing between 2010 and 2024 to analyse their epidemiological characteristics, spatio-temporal distribution and high-risk areas. The data included demographic characteristics, epidemiological history, clinical manifestations and diagnostic criteria. We established a database using Microsoft Excel, performed time series analysis and Kruskal–Wallis tests with R software, and used ArcGIS for global and local spatial autocorrelation analyses to identify spatio-temporal clustering patterns. A total of 1986 cases were reported from 13 institutions, including 33 (1.66%) confirmed, 468 (23.57%) clinically diagnosed and 1485 (74.77%) suspected cases. Cases were predominantly male (69.74%) and young, with 85.95% under 20 years old and most having low educational attainment. Cases showed a significant declining trend (Mann–Kendall τ = −0.676) and strong seasonality, with 56.20% occurring between March and August (H = 17.108). Spatial analysis revealed significant global positive correlation (Global Moran’s I = 0.337), with northeastern Chongqing as a stable high-risk cluster and the western region as a low-risk cluster. Paragonimiasis in Chongqing demonstrates distinct gender, age, seasonal and spatial patterns. Targeted health education, improved diagnosis and strengthened surveillance in northeastern Chongqing are essential for effective prevention and control.