Objective To identify the main influencing factors of human alveolar echinococcosis (AE) in Baqing County, Xizang Autonomous Region, so as to provide insights into echinococcosis control in pastoral areas. Methods Based on the human echinococcosis screening programme in Baqing County, Xizang Autonomous Region from January 2023 to October 2024, AE patients that were definitively diagnosed with abdominal B‑mode ultrasonography and based on WS 257-2006 Diagnostic Criteria for Echinococcosis were selected as the case group, and residents that were free of echinococcosis as revealed by abdominal B-mode ultrasonography during the same time served as controls. Matching was performed based on the same gender, similar age (± 5 years), and residence in the same or geographically adjacent administrative villages, with one case matched to two controls. From September 2024 to May 2025, a face to face questionnaire survey was conducted by uniformly trained investigators, and the questionnaire covered general demographics, dog breeding and management, environmental exposure factors, and personal behavioral habits. All statistical analyses were performed using the software R, with chi square test used for between group comparisons, and a conditional logistic regression model for identifying factors affecting the risk of AE. Results A total of 258 residents from Baqing County were enrolled, including 86 cases in the case groups and 172 matched controls, and all subjects were Tibetan residents. The mean age was (44.6 ± 14.2) years in the case group and (44.1 ± 14.1) years in the control group, with no statistically significant difference （t = 0.26, P > 0.05）, and no significant differences were observed in gender, occupation, educational level, body mass index, marital status, or household size (χ² = 0.00, 1.53, 0.83, 4.09, 0.71 and 0.53, all P > 0.05). Univariate conditional logistic regression analysis identified significant associations of dog breeding (OR = 2.82, 95% CI: 1.45-5.48), never deworming for dogs (OR = 3.22, 95% CI: 1.09-9.48), improper disposal of dog feces (OR = 4.86, 95% CI: 2.09-11.30), frequent contact with dogs (OR = 2.98, 95% CI: 1.42-6.24), presence of foxes around the residence (OR = 2.42, 95% CI: 1.37-4.27), use of river/stream water as the main drinking water source (OR = 2.55, 95% CI: 1.26-5.16), drinking unboiled water (OR = 2.02, 95% CI: 1.17-3.48), and frequent consumption of unwashed fresh Cordyceps (OR = 3.87, 95% CI: 1.55-9.67) with the risk of AE (all P < 0.05), and multivariate analysis identified dog breeding duration for > 5 years (OR = 4.68, 95% CI: 1.09-20.17), non disposal of dog feces (OR = 9.35, 95% CI: 2.39-36.64), frequent contact with dogs (OR = 6.92, 95% CI: 1.21-39.51), and drinking water sourced from rivers, lakes, ditches, or ponds (OR = 4.97, 95% CI: 1.07-23.20) as main risk factors for AE. Conclusion The development of human AE is closely associated with dog management and drinking water safety in Baqing County. It is recommended to reinforce dog management and standardized disposal of dog feces, improve drinking water sanitation, and enhance health education among herders.