Objective   To understand the under-registration of pulmonary tuberculosis (TB) and analyze the influencing factors and reasons in Hubei province in 2019.

  Methods   A stratified random sampling method was used to select designated and non-designated tuberculosis medical institutions with tuberculosis diagnosis capabilities in counties and cities of Hubei to conduct a survey of registration of pulmonary TB cases and suspected pulmonary TB cases in 2019, and evaluate the status of the under-registration.

  Results   The information of 21591 pulmonary TB cases were collected from 6 medical institutions, finally, the information of 3285 cases were analyzed. In 2019, the under-registration rate of pulmonary TB in Hubei was 10.23%. There were statistically significant differences in under- registration rate among the institutions with different nature (χ²=42.933, P<0.001), institutions of different types (χ²=6.747, P=0.009), cases with different diagnosis classification (χ²=18.266, P<0.001), areas with different epidemic situation (χ²=21.989, P<0.001) and hospitals with different outpatient visits (χ²=24.053, P<0.001). The risk for under-registration of pulmonary TB was higher at city level (compared with the county level, OR=2.27, 95%CI: 1.77−2.92) and in tuberculous pleurisy cases (compared with rifampicin-resistant tuberculosis cases, OR=6.71, 95 %CI: 1.90−23.74). Failure to follow up and one-off visits were the main reasons for the under-registration of pulmonary TB.

  Conclusion   It is necessary to pay attention to the under-registration of pulmonary TB, improve the service capacity of the TB prevention and control system, and strengthen the standardized diagnosis and treatment of pulmonary TB in hospitals in Hubei.