Abstract: Objective To analyze the epidemiological characteristics of the spontaneous reactivation of hepatitis B surface antigen (HBsAg) carriers in the community, and to provide a scientific management for the chronic hepatitis B virus (HBV) carriers. Methods A serum epidemiological cross-sectional study was conducted in September 2010, and the HBsAg carriers cohort was established. Then the cohort was followed in 2012 and 2014 to clarify the HBV reactivation rate and epidemiological characteristics. Results After the follow-up, there were 72 carriers developed to HBV reactivation of 852 HBsAg carriers. The spontaneous reactivation incidence was 2 746.8 per one hundred thousand person-years. Different reactivation rate were observed in different gender (χ²=3.901,P=0.048). The male accumulated reactivation rate was 10.39%, which was higher than that of the female (6.62%). Meanwhile, significant differences were also found in different age groups (χ²=6.524,P=0.038). The reactivation rate of 46-59 age group was 11.95%. Besides, when the deoxyribonucleic acid of hepatitis B virus (HBV DNA) level was high, the reactivation incidence was rising (χ²=10.404,P=0.006). Especially in the HBV DNA level >1×10⁵ IU/ml group, the reactivation rate could reach 14.36%. Conclusions The HBsAg carriers may develop to HBV reactivation among community. Male, middle-age period and high baseline HBV DNA load are important risk factors for hepatitis B virus (HBV) reactivation. Therefore, we should enhance the management of HBV carriers, conduct regular follow-up to monitor the condition change, and choose the reasonable time to initiate treatment.