Abstract: Objective: To analyze the trends and influencing factors of health literacy among residents in Nanning from 2020 to 2024, so as to provide a scientific basis for developing health education intervention strategies. Methods: The stratified chi-square test was used to analyze the differences in health literacy levels among populations with different characteristics. The binary logistic regression model was applied to identify independent factors influencing residents’ health literacy levels. Trend analysis was conducted using the chi-square test for linear trend, estimated annual percentage change（EAPC）, absolute increase, average annual absolute increase, and average annual growth rate. Results: From 2020 to 2024, the overall health literacy level of Nanning residents, as well as the health literacy levels across three dimensions and six types of health issues, showed an upward trend(χ²_trend=25.898-146.939, P＜0.01). Specifically, the overall health literacy level increased from 21.58% to 32.75%, with an absolute increase of 11.17%, an EAPC of 11.29%, an average annual absolute increase of 2.79%, and an average annual growth rate of 10.99%. Among the three dimensions, the possession rate of basic health knowledge rose to 48.27%, while healthy lifestyle and behavior showed the largest increase（10.58%）. However, basic skills remained the lowest（only 26.71% in 2024） and had the slowest growth rate（average annual growth rate of 7.50%）. Among the six types of health issues, scientific health perspectives（56.85%） and safety and first-aid literacy（65.62%） maintained high levels. Infectious disease prevention（30.98%） and basic medical literacy（30.77%） started from a low baseline and grew slowly. Chronic disease prevention literacy exhibited the fastest growth（EAPC=11.97%, average annual growth rate=11.33%）, while health information literacy improved relatively quickly（EAPC=10.30%, average annual growth rate=9.42%）. Multivariate analysis indicated that education level（OR=2.720-16.469） and age（OR=0.473-1.536） were the main influencing factors of health literacy. Rural residents showed greater potential for improvement（OR=1.926）. Conclusion: The health literacy among Nanning residents has improved significantly, but challenges remain, including weak basic skills, stagnant growth in infectious disease prevention, and slow improvement in health literacy among populations with low education levels and advanced ages. Targeted interventions for vulnerable groups and weak areas are recommended to promote the balanced development of health literacy.