Data from two cross-sectional investigations on 7,138 subjects were used to explore risk factors of human alveolar echinococcosis (AE) in Tibetan communities. The overall human AE prevalence was 3.1% (223 of 7,138), females had a higher prevalence (3.6%, 132 of 3,713) than males (2.7%, 91 of 3,425; P = 0.011), and herdsmen had a higher prevalence (5.2%, 154 of 2,955) than farmers (1.8%, 12 of 661; P < 0.001) and urban populations (2.1%, 49 of 2,360; P < 0.001). Age in all populations, number of dogs kept, fox skin ownership in farmers, not preventing flies from landing on food in herdsmen, using open streams as drinking water sources, and playing with dogs in urban populations were statistically significant risk factors. The results suggest that AE is highly endemic in the eastern Tibetan plateau, in Sichuan Province, the role of the dog is important for human infection, and other factors associated with environmental contamination may vary according to structure and practices of communities.