To analyze the reported incidence of pulmonary tuberculosis (TB) in Qinghai Province from 2005 to 2024, and to provide a scientific basis for developing adaptive TB prevention and control strategies.

Data on reported TB cases in Qinghai, categorized by year, sex, occupation, age group, and region, were extracted from the infectious disease surveillance module of the China Information System for Disease Control and Prevention. The joinpoint regression model was used to analyze the temporal trends in the reported incidence under different categories.

From 2005 to 2024, a total of 119 984 TB cases were reported in Qinghai Province, with an average of approximately 5 999 cases annually. The average annual reported incidence rate was 104.12 per 100 000 population. Joinpoint regression analysis indicated no significant overall trend for the entire period. However, the reported incidence showed a slow upward trend from 2005 to 2018 [Annual Percent Change (APC)=4.24%, P<0.001], followed by a significant downward trend from 2018 to 2024 (APC=-10.89%, P=0.001). A turning point occurred in 2018 for both males and females: incidence increased during 2005—2018(male: APC=2.91%, P=0.005; female: APC=6.17%, P<0.001) and decreased markedly during 2018—2024 (male: APC=-11.85%, P<0.001; female: APC=-10.00%, P=0.003). By age group, the 0-14 years group showed a significant increasing trend [Average Annual Percent Change (AAPC)=5.05%, P<0.001], while the ≥65 years group showed a significant decreasing trend (AAPC=-2.47%, P=0.042). Regarding occupational distribution, farmers constituted the highest proportion at 42.16%,followed by herdsmen (24.08%), and students (11.93%). The reported incidence among herdsmen and students showed increasing trends from 2005 to 2024. Among the prefectures, Xining City and Haixi Prefecture showed decreasing trends(Xining: AAPC=-4.84%, P<0.001; Haixi: AAPC=-5.23%, P<0.001), while Huangnan Prefecture showed an increasing trend(AAPC=3.87%, P=0.003).

The reported incidence of pulmonary tuberculosis in Qinghai Province showed an initial increase followed by a decrease between 2005 and 2024. Sustained efforts are needed to enhance etiological detection capacity,strengthen active screening in key regions and high-risk populations, and improve TB surveillance and early warning capabilities among students/children to further reduce the disease burden.