Objective  To analyze the current status, trend of detection delay of pulmonary tuberculosis cases, and influencing factors in Nanjing, Jiangsu province, from 2014 to 2023 and provide evidence for the improvement of pulmonary tuberculosis diagnosis.

Methods The information of pulmonary tuberculosis cases living Nanjing from 2014 to 2023 were collected from Tuberculosis Management Information System of Chinese Center for Disease Control and Prevention for a descriptive epidemiological analysis on the distribution of delayed diagnosis of pulmonary tuberculosis cases in Nanjing. Joinpoint regression model was used to analyze the temporal trend of the rate of delayed diagnosis, and logistic regression model was used to identify the factors influencing the delayed diagnosis.

Results  From 2014 to 2023, the median time for the diagnosis of pulmonary tuberculosis in Nanjing was 30 days, and the average delay rate was 54.28% (13 155/24 236). The detection delay rate increased from 48.13% in 2014 to 56.04% in 2023. However, the overall trend showed no significant difference average annual percentage change (AAPC)=1.23%, 95%CI: −1.27% to 3.80%, t=0.957, P=0.339. Multivariate logistic regression analysis showed that women (OR=1.24, 95%CI: 1.17−1.31, P < 0.001), those aged 45−<60 years (OR=1.47, 95%CI: 1.36−1.58, P < 0.001), those aged ≥60 years (OR=1.62, 95%CI: 1.50−1.75, P < 0.001), key groups (OR=1.06, 95%CI: 1.00−1.13, P=0.036), and those with positive pathogen test results (OR=1.29, 95%CI: 1.22−1.36, P<0.001) were more likely to have delays in seeking medical care, The age group 15−<25 years (OR=0.87, 95%CI: 0.79−0.97, P=0.013) and students and children (OR=0.80, 95%CI: 0.66−0.96, P=0.015) were less likely to have delays in seeking medical care. Women (OR=1.09, 95%CI: 1.03−1.16, P=0.006) and those with other or unknown occupations (OR=1.18, 95%CI: 1.03−1.35, P=0.015) were more likely to have diagnosis delays. Those aged ≥60 years (OR=0.89, 95%CI: 0.82−0.97, P=0.008), key groups (OR=0.83, 95%CI: 0.78−0.89, P<0.001), students and children (OR=0.79, 95%CI: 0.65−0.96, P=0.017), healthcare workers (OR=0.60, 95%CI: 0.43−0.84, P=0.003), farmers (fishermen, seafarers, and migrant workers) (OR=0.61, 95%CI: 0.53−0.70, P<0.001), and those with positive pathogen test results (OR=0.73, 95%CI: 0.69−0.77, P<0.001) were less likely to have diagnosis delays.

Conclusion The delayed detection of pulmonary tuberculosis cases was severe in Nanjing. Close attention should be paid to the hospital visit delay in women, middle age and elderly population and key groups for pulmonary tuberculosis and the pulmonary tuberculosis diagnosis delay in women and non-key groups. It is necessary take comprehensive measures to improve the detection of pulmonary tuberculosis.