Objective To analyze the pertinence between HAPE and the various altitude areas after a rapid land on, and investigate the related pathogenic situation and risk factors. Methods Eighty-seven patients with acute altitude disease (including high altitude pulmonary edema) in our hospital were retrospectively analyzed. Patients with HAPE after rapid elevation were divided into two groups according to different altitude areas (group A: 2500-3500 m, group B: 3501-4500 m), including 49 cases in group A and 38 cases in group B. t test and χ2 test were used to analyze the incidence of HAPE patients at different high altitudes (oxygen saturation, respiration, heart rate, body temperature, white blood cell count, imaging changes, pulmonary signs, and outcomes after descending to the same altitude). Binary Logistic regression analysis was performed to analyze the risk factors associated with HAPE. Results Of the 87 included subjects, 92.1% were HAPE patients in group B and 26.5% in group A. On admission, the blood oxygen saturation of group B was significantly lower than that of group A, the total number of white blood cells, heart rate and respiration were significantly higher than that of group A. The incidence of positive pulmonary signs (wet rale) and positive imaging (double lung patular shadow) in group B was also higher than that of group A (P<0.05). The body temperature of group B was higher than that of group A. There was no significant difference between the two groups (P>0.05). Logistic regression analysis showed that altitude, sex, underlying disease and place of residence were all independent risk factors for HAPE, and the OR value of those with underlying disease was the highest (OR=17.667). Conclusion There are significant differences in the incidence of HAPE at different altitudes. Factors such as altitude, gender, place of residence and underlying diseases have significant effects on HAPE, especially those with underlying diseases have a higher risk. The above study will provide theoretical basis for reducing the incidence of HAPE in high-altitude regions for soldiers, tourists and workers who enter the plateau