China’s grain security situation has held up fairly well, but regional contradictions cannot be ignored. Optimizing the regional layout of grain security is conducive to enhancing the ability to prevent grain security risks. From the perspective of grain usage, this paper estimates the grain demand of 31 provinces and cities from 2013 to 2018, divides grain production and demand into 6 different levels, analyzes the temporal and spatial evolution of China’s grain production and demand balance, and calculates the spatial autocorrelation. Results show that: 1) From 2013 to 2018, China’s high-yield areas increased production while low-yield areas reduced production. Food production focused on high-yield regions, and the provincial gap in grain production continued to grow; 2) Food and feed grains are two essential parts of the total grain demand structure. The indirect grain consumption and total grain demand changes show a spatial shift of “decreasing in the north and increasing in the south” and “decreasing in the East and increasing in the West”; 3) Although Shandong, Sichuan and Liaoning are the main grain-producing areas, they also show high grain shortages. The provinces with sufficient grain to export are Heilongjiang, Jilin, Inner Mongolia, Henan, Anhui, Xinjiang and Gansu. From 2013 to 2018, the imbalances between grain production and demand in most provinces and cities have been getting better, and the level of grain security at the provincial level has been improved; And 4) China’s grain production and demand show a positive spatial correlation, with a state of agglomeration. Moreover, the spatial agglomeration of poor grain demand and production is more robust and more stable. High surplus grain areas are concentrated in northern regions such as Heilongjiang, Inner Mongolia, and Xinjiang while high grain deficit areas are located in the southeast coast. Based on the above analysis, the paper draws some policy implications: to balance the relationship between direct food demand and indirect food demand, and between grain surplus and grain shortage areas, to improve the food circulation system, and to strengthen the grain supply chain management.