Objective Analyzed the epidemiological characteristics and spatiotemporal distribution of pulmonary tuberculosis (TB) in the elderly aged≥65 years in Shaanxi Province from 2015 to 2024, and provide evidence for the development of targeted prevention and control strategies for key populations.

Methods Data on reported pulmonary TB among individuals aged ≥65 years in Shaanxi from 2015 to 2024 were collected from the Tuberculosis Information Management System of the Chinese Center for Disease Control and Prevention. Software Joinpoint 5.4.0 was used for trend analysis. Global spatial autocorrelation and hotspot analysis were performed at the county (district) level by using software ArcGIS 10.8. Spatiotemporal scanning analysis was conducted by using software SaTScan 10.0.

Results The reported incidence rate of pulmonary TB in the elderly ≥65 years in Shaanxi decreased from 118.75/100 000 in 2015 to 86.89/100 000 in 2024, with an average annual percentage change of −4.86%. The downward trend in the reported incidence rate was significant (t=−5.105, P<0.001). The annual Moran's I values ranged from 0.22 to 0.34 (all P < 0.001), indicating a spatially clustered distribution. Hotspot areas were mainly identified in Yulin, Yan'an, and Ankang, showing a significant clustering trend. From 2015 to 2024, a total of 44 spatiotemporal clustering areas) were detected in Shaanxi (all P<0.001, mainly distributed in Yulin and Yan'an during 2015−2019 and Ankang during 2015−2018.

Conclusion The reported incidence rate of pulmonary TB in the elderly aged ≥65 years in Shaanxi showed an overall downward trend from 2015 to 2024. The incidence exhibited significant spatiotemporal clustering, with hotspot areas and spatiotemporal clustering areas being highly consistent, mainly distributed in some counties (districts) of northern and southern Shaanxi. This suggests that targeted prevention and control measures should be developed for the elderly population in high-incidence clustering areas.