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• This was a large sample study of 538,500 individuals to investigate the prevalence of anxiety in students. • The prevalence of anxiety symptoms among chinese primary school students was higher at 13.4%. • After adjusting for potential confounders, school location, knowledge and protective practices of COVID-19 were found to be associated with anxiety symptoms. • Good knowledge of COVID-19 was associated with a lower prevalence rate, which was higher in rural areas, but there was little difference between levels of protection practice. This study was conducted on elementary school students in Henan Province, China, from February 4th to 11th, 2020, during the coronavirus disease 2019 (COVID-19) epidemic. The purpose of the study was to examine the prevalence of anxiety among students and identify the related risk factors contributing to anxiety. Demographic information and psychological status were assessed by using self-reported measures. The generalized anxiety disorder tool (GAD-7) and a multiple logistic regression model were used to assess anxiety and identify potential influencing factors. Cross-sectional data indicated that the overall anxiety prevalence was 13.4%. The prevalence of anxiety symptoms was highest among rural primary school students and lowest among city students. Three groups of students in different regions were surveyed, and the prevalence of anxiety symptoms was significantly higher among students with poor knowledge of COVID-19 than among students with good knowledge of COVID-19. After adjusting for potential confounding factors, it was found that location, knowledge, and practice were related to anxiety. This study showed that the prevalence of anxiety symptoms was higher among Chinese primary school students. The influencing factors found in this study may help relevant staff improve the mental health of children during the epidemic. [ABSTRACT FROM AUTHOR]