Objective To investigate the demographic characteristics and prevalence of liver fibrosis among individuals with a history of schistosomiasis in lake-marsh type endemic area, providing evidence for the early prevention, detection, and intervention of advanced schistosomiasis. Methdos Individuals registered as previously infected with Schistosoma japonicum in Jiangling County, Hubei Province between 2008 and 2012 were selected through cluster sampling. A structured questionnaire was used to collect demographic data. Liver fibrosis was assessed by Doppler ultrasound. The four liver fibrosis indicators were detected using chemiluminescence assay, and the liver function biochemical indicators were measured with the automated biochemical analyzer. The anti-schistosome antibodies were detected using the indirect hemagglutination assay (IHA). Statistical analyses were performed using R software version 4.0.0. Chi-square tests were applied to categorical variables, and one-way ANOVA was used for continuous variables. Results A total of 514 individuals with a history of schistosome infection were included, the ratio of male/female was 1.28∶1, with a mean age of (61.63 ± 9.63) years. Ultrasound results indicated that 28.21% (145/514) individuals had normal liver parenchyma, 36.19% (186/514) had mild liver fibrosis, and 35.60% (183/514) had moderate to severe liver fibrosis. Statistically differences in liver fibrosis severity were observed across different sex and age groups (χ² = 14.48, 39.34; both P < 0.01). The proportions of abnormal liver morphology were 13.97% (20/145), 28.49% (53/186), and 34.97% (64/183) in individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis, respectively (χ² = 19.07, P < 0.01). Mean spleen thickness of individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis were (29.72 ± 4.62), (30.37 ± 5.00), and (31.34 ± 4.88) mm, respectively (F = 4.58, P < 0.05); and the portal vein diameters were (10.47 ± 0.80), (10.32 ± 0.76), and (10.58 ± 0.87) mm, respectively (F = 9.59, P < 0.01). The abnormal rates of hyaluronidase (HA) among the individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis were 18.62% (27/145), 28.50% (53/186), and 39.34% (72/183), with a statistically difference (χ² = 16.84, P < 0.01). There were no statistically differences observed in other liver fibrosis indicators (procollagen Ⅲ, laminin, or collagen type Ⅳ) or liver function biochemical indicators (total bilirubin, total protein, albumin, alanine aminotransferase, or aspartate aminotransferase). IHA results indicated that 94 individuals tested positive for anti-schistosome antibodies, corresponding to an overall antibody positivity rate of 18.29%; the antibody positivity rate among the individuals with normal liver parenchyma, mild liver fibrosis, and moderate to severe liver fibrosis were 15.17% (22/145), 20.97% (39/186), and 18.03% (33/183), respectively (χ² = 1.84, P > 0.05). No cases were found to be positive on parasitological examination. Conclusion Individuals with a history of schistosomiasis in marshland-endemic regions exhibit a high prevalence of liver fibrosis and antibody positivity. The severity of fibrosis correlates with abnormal liver morphology, increased spleen thickness, portal vein dilation, and elevated HA levels. Enhanced monitoring, targeted management, and early intervention in this population are essential to reduce the burden of advanced schistosomiasis.