Trends and Determinants of Patient Delay among Pulmonary Tuberculosis Patients in Yantai City, Eastern China: A 16-Year Population-Based Surveillance Study (2010–2025)

Background Prolonged patient delay (PrPD) increases disease severity and transmission risk, undermining tuberculosis (TB) control efforts. This study aims to describe the patient delay among patients with pulmonary tuberculosis (PTB) and identify the influencing factors. Methods A retrospective cohort study was conducted using data extracted from the national Tuberculosis Management Information System (TBMIS) in Yantai City between 2010 and 2025. Joinpoint regression evaluated annual trends in PrPD proportion. Univariable and multivariable logistic regression analyses were used to identify factors associated with PrPD. Results The overall PrPD proportion of PTB patients was 65.25% with a median delay of 26 days (IQR: 9–60 days). Despite an overall significant decline over the 16-year period (AAPC = − 1.362%, P = 0.013), joinpoint analysis revealed a markedly divergent pattern: a significant increase during 2010–2023 (APC = 1.552%, P < 0.001) followed by a sharp reversal and significant decline during 2023–2025 (APC = − 18.368%, P < 0.001). Multivariable analysis revealed that older age (25–44 years, aOR = 1.233; 45–64 years, aOR = 1.572; ≥65 years, aOR = 1.432), migrant residential status (aOR = 1.610), passive case finding (aOR = 3.904), bacteriologically positive results (aOR = 1.245), and during the COVID-19 pandemic (aOR = 1.255) were independent risk factors for PrPD. In contrast, non-farmers (aOR = 0.784), and post-COVID-19 pandemic periods (aOR = 0.728) were protective factors associated with lower PrPD odds. Conclusions To reduce PrPD and mitigate TB transmission in Yantai City, targeted interventions should prioritize elderly individuals, farmers, and migrant populations, including strengthened active case-finding, improved health education, enhanced healthcare access for migrants, and more equitable allocation of medical resources. Future TB control strategies should adopt context-adapted, integrated approaches to promote early detection and timely treatment, with a focus on vulnerable populations.