Background: We aimed to explore the risk factors of lung nodules and lung cancer in physical examination population with low-dose multi-slice spiral CT (LDCT) screening, to provide basis for lung cancer screening and follow-up management after CT examination.Methods: The general data, serum tumor markers and CT images of 2,274 patients underwent LDCT in the Physical Examination Center of the Fourth Hospital of Hebei Medical University, China in 2019 were retro-spectively analyzed and followed up for three years.Results: The detection rate of lung nodules was 48.42%. The detection rate of lung nodules was higher in fe-males, those over 70, those with history of smoking, passive smoking, drinking, precious history of lung diseas-es and family history of malignant tumors, with statistically significant differences (P < 0.05). The abnormal rate of serum tumor markers (CA199, CA125 female and CYFRA211) were higher than that in the non-nodule group, with statistically significant differences (P < 0.05). Multivariate logistic regression analysis showed that gender, age, history of smoking, passive smoking, family history of malignant tumors and serum tumor markers (CYFRA211 and CA199) were independent risk factors for the occurrence of lung nodules.Conclusion: Gender female, age > 35, history of smoking, passive smoking, history of drinking, history of past lung disease, family history of malignant tumors, abnormal CYFRA211 tumor markers were detected and low dose multi-slice spiral CT image showed ground-glass nodules are risk factors for lung nodules and lung cancer, which should be paid close attention to during physical examination and follow-up.