Background: Echinococcoses are neglected zoonotic parasitic diseases that disproportionately impacts pastoral and rural populations, especially in endemic regions of northwest China. Among these, Xinjiang still remains one of the most heavily affected areas. Despite this, long-term studies that examine spatial clustering, transmission dynamics, and future trends at fine spatial scales and integrate human, animal, and environmental data have yet to be carried out.Methods: Using surveillance data from Xinjiang spanning 2005 to 2024, we conducted a comprehensive spatiotemporal analysis of human echinococcoses. Both global and local spatial autocorrelation analyses were used to identify clustering patterns. Kriging interpolation was applied to estimate spatial distribution of infection rates among intermediate and definitive animal hosts. Furthermore, Bayesian spatiotemporal models were developed to assess incidence trends, evaluate associations with environmental factors, and predict future transmission patterns.Findings: A total of 21,822 human echinococcoses cases were reported in Xinjiang during the study period. Significant spatial clustering was identified, with prominent “high-high” incidence clusters located in the Yili River Valley in northern Xinjiang and Wuqia County in southern Xinjiang. Bayesian modeling revealed persistent transmission in these regions and predicted that they will remain major centers of echinococcoses incidence in the future. Varying levels of infection risk were also observed in other endemic areas. Environmental and host-related factors contributed to the heterogeneous spatial distribution of disease risk across the region. Human echinococcoses continues to pose a substantial public health burden in Xinjiang, characterized by clear spatial clustering and sustained transmission in high-risk areas. Interpretation: These findings highlight the urgent need for strengthened, geographically targeted control strategies that prioritize high-incidence clusters and integrate a One Health approach to reduce transmission and mitigate future disease burden.