Objective To analyze the spatiotemporal evolution and convergence characteristics of pulmonary tuberculosis (TB) incidence in China(except Hong Kong, Macao Special Administrative Regions and Taiwan region, the same below), and provide evidence for the development of precise and effective pulmonary TB prevention and control strategies.

Methods Based on the incidence data of pulmonary TB from 31 provinces in China between 2010 and 2021, this study used kernel density function, standard deviation ellipse, and spatial convergence models to analyze the dynamic evolution, spatial distribution deviation and convergence of incidence rates of pulmonary TB in China.

Results During the study period, the average annual decline rate of pulmonary TB incidence was 2.68% in China (annual percent change=−2.68%, P<0.001). This decline was characterized by a steady decrease from 2010 to 2018 average annual percent change（AAPC）=−2.54%, P<0.001 and a sharp decrease from 2018 to 2021 (AAPC=−8.11%, P=0.022). The absolute difference in pulmonary TB incidence between the national average and the eastern region average decreased, while the absolute difference between the central region average and western region average increased slightly. The standard deviation ellipse area expanded from 486.88 km² in 2010 to 493.25 km² in 2021, with the major axis increasing by 56.94 km and the minor axis shortening by 34.09 km, indicating an increase in the flattening ratio by 0.06 and a decrease in the azimuth angle by 0.40°, the center of gravity of the ellipse was in the west and south of China. There was absolute β-convergence and conditional β-convergence in TB incidence nationwide, as well as in the eastern and western regions, while only conditional β-convergence existed in the central and northeastern regions.Additionally, the number of beds in health institutions (β=0.00), average temperature (β=−0.03) had significant negative impacts, while medical and health fiscal expenditure per capita (β=0.00) had significant positive impact on the convergence of national incidence rate of pulmonary TB.

Conclusion The incidence of pulmonary TB in China was in decrease, but regional imbalance remained. The spatial distribution showed an expansion to northwest and southeast regions. The differences in pulmonary TB incidence rate among national, eastern region and western regions decreased. At the same time, factors such as health worker count per 10000 persons, hospital bed count, medical and health fiscal expenditure per capita and average temperature inhibited the increase of pulmonary TB incidence in different regions.