To analyze the prevalence of silicosis in the militias with contribution to the former Xiangyu Railway construction in Nanchong, China, from 2008 to 2017, and to provide a scientific basis for the future development of pneumoconiosis prevention and control strategies based on the current status. A database was established for the data of 11863 militias with contribution to the former Xiangyu Railway construction in Nanchong, China, who attended our hospital from 2008 to 2017, including 11485 males (96.81%) and 378 females (3.19%). The SPSS 17.0 software was used to analyze the differences in the detection rate of silicosis between militias with different sexes or those with different job types, as well as the age, length of service, and regional distribution of patients. Of the 11863 railway militias in Nanchong, 3169 (26.71%) were diagnosed with silicosis, including 2761 (87.12%) in stage I, 359 (11.33%) in stage II, and 49 (1.55%) in stage III; the males had a significantly higher detection rate of silicosis than the females (χ(2)=64.496, <0.05); there was a significant difference in the detection rate of silicosis between the militias with different job types (χ(2)=856.839, <0.05). There were significant differences in the mean age of diagnosis and the mean length of service between the patients with different stages of silicosis (=4.944, <0.05; =3.174, <0.05). There was a significant difference in the number of militia patients with silicosis between different areas of Nanchong (χ(2)=843.330, <0.05). The prevalence of silicosis is relatively high among the militias with contribution to the former Xiangyu Railway. It is necessary to strengthen the occupational health monitoring of patients, actively treat and prevent complications, and improve the quality of life of patients.