Abstract: Objective To determine the prevalence of positive HBsAg and negative HBsAg populations in rural Mianyang, and provide evidence support for proper immunization strategies. Methods A questionnaire survey was conducted on 163 797 rural residents in Mianyang selected through a multistage random sampling strategy. Serum samples were taken from the participants to detect HBsAg and HBsAb with enzyme-linked immunosorbent assay (ELISA). Results Overall, 6.57% 〔95% confidence interval (CI): 6.45%-6.69%〕 of participants were HBsAg positive. In those with negative HBsAg, 40.32% (95%CI: 40.36%-40.84%) had negative HBsAb. Higher prevalence of positive HBsAg was found in the male participants (7.74%) compared with the females (5.73%). But the male participants with negative HBsAg were less likely to have negative HBsAb (39.93%) than their female counterparts (40.61%). Those aged between 56 and 65 years had the highest prevalence of positive HBsAg (7.36%); whereas, those aged between 86 and 96 years had the highest prevalence of negative HBsAg/HBsAb (47.61%). The participants who were married (6.63%), resided in Fucheng District (9.23%), had a family history of Hepatitis B (21.01%) and were not vaccinated (7.30%) had higher prevalence of positive HBsAg than others. Those who were divorced and widowed (43.04%), resided in An County (55.24%), had no family history of Hepatitis B (40.60%), and were vaccinated (40.92%) had higher prevalence of negative HBsAg/HBsAb than others. These differences were statistically significant (P<0.05). Conclusion A high proportion of ruralresidents in Mianyang are HBsAg positive or HBsAg/HBsAb negative. The older population and those without vaccination should be the main target in the prevention and control of hepatitis B.