<p>This study investigated the spatio-temporal variations of soil radionuclides in Chongqing (2016–2023) and assessed their associated health risks. Using descriptive, correlation, and mixed-effects model analyses, the activity concentrations and distribution of soil radionuclides (¹³⁷Cs, ²³⁸U, ²³²Th, ²²⁶Ra and^{<CitationRef CitationID="CR40">40</CitationRef>} K) were examined. AEDE, Ra_eq, ELCR, ADR were calculated. Spatially, after controlling for temporal variation, the Urban New Area showed higher ²²⁶Ra and ²³⁸U than the Urban Core Area, while the Southeast Wuling Mountain Area had higher ²²⁶Ra, ¹³⁷Cs and ²³⁸U. Temporally, after controlling for regional variation, ⁴⁰K (2023, 2021), ²³²Th (2018–2023) and ²³⁸U (2021) all exhibited higher activity concentrations than in 2016. The calculated health risk indices (AEDE, Ra_eq, ELCR, ADR) were above global averages, indicating a need for targeted soil management. Specifically, levels of ²²⁶Ra and ²³⁸U in the Urban New Area, and of ²²⁶Ra, ¹³⁷Cs, ²³²Th and ²³⁸U in the Southeast Wuling Mountain Area, require prioritization.</p>