Objective To provide a scientific basis for pandemic control and prevention by analyzing the epidemiological and clinical characteristics of imported and local COVID-19 cases in Gansu province. Methods A total of 169 confirmed COVID-19 cases reported by 20 designated hospitals in Gansu province during January 23 and September 3 2020 were analyzed in this study, including 79 imported cases (the imported group, consisting of Chinese patients from overseas who were confirmed to have COVID-19 during institutional quarantine and observation) and 90 local cases (the local group). A comparative analysis was performed on the 169 COVID19 cases, which involved epidemiological characteristics, clinical manifestations, laboratory test results, and chest imaging findings. Results In the imported group, there were 59 male patients and 20 female patients with a mean age of (28±11) years. In the local group, there were 31 male patients and 59 female patients with a mean age of (44±17) years. The differences between the two groups in the numbers of male and female patients were statistically significant (x2=3.818 and 3.667, P＜0.01, respectively). Patients in the local group were significantly older than those in the imported group (t=6.240, P＜0.01). There are significantly more severe/critical cases in the local group than in the imported group（x2=9.137，P＜0.01）. The incidence rates of fever, cough, and fatigue in the imported group were significantly lower than in the local group (x2=15.418, 15.764, and 10.929, P＜0.01, respectively). The two groups showed no statistically significant differences in the levels of white blood cells (WBC), the percentage of neutrophils (%NEU), and aspartate transaminase (AST) (t=-0.86 and 1.440，Z=1.585; P＞0.05, respectively). Differences between the two groups had statistical significance in the count of lymphocytes (L), and the levels of C-reactive protein (CRP), alanine transaminase (ALT), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), glutamyl transpeptidase (GTP), lactate dehydrogenase (LDH), and D-dimer (Z=-4.127, -4.116, -2.604, -3.902, 2.436, -4.224, -2.158, -2.016, -2.679 and -3.339;P＜0.05, respectively). The arterial oxygen saturations of the local group was significantly lower than that of the imported group (Z=-4.772, P＜0.05). The patients receiving respiratory support of the local group were significantly more than the imported group (x2=10.167, P＜0.01). Chest imaging findings demonstrated that in the imported group, lesions were mainly distributed in a unilateral lung; in the local group, lesions were found in the bilateral lungs. Imaging changes in the lungs were predominately nodular opacities in the imported group, followed by groundglass opacities, whereas those in the local group were mainly ground-glass opacities and consolidative opacities. Conclusion In Gansu province, the imported COVID-19 cases are mostly young people, and there are few severe/critical patients. Compared with local cases, the clinical symptoms are milder, the lesion area is smaller, the density is more uniform, the systemic inflammatory response is milder, and the influence on coagulation indicators is milder. It has less impact on the function of organs such as the heart and liver, and fewer patients need respiratory support.