Objective: To analyze the epidemic characteristics and treatment outcomes of pulmonary tuberculosis patients aged ≥65 years old in Ningxia from 2019 to 2022 and to provide epidemiological basis for further prevention and control in the elderly tuberculosis cases. Methods: The number of whole population and that of population aged ≥65 years, number of pulmonary tuberculosis cases, age, sex, diagnosis category, treatment category, case finding ways, residence location, occupation, and treatment outcome in Ningxia in 2019-2022, were retrospectively extracted from the statistical analysis of tuberculosis module in the “Infectious Disease Surveillance System” subsystem of the “China Disease Prevention and Control Information System” and the integrated management of disease prevention and control module and the characteristics of the epidemic situation and the treatment outcome were analyzed. Results: From 2019 to 2022, the average notification rates of pulmonary tuberculosis and the pathogenic positive patients among the population aged ≥65 years old were 114.59/100000 (3155/2753300) and 74.42/100000 (2049/2753300), respectively. The notification rates decreased from 137.87/100000 (864/626700) and 86.64/100000 (543/626700) in 2019 to 99.53/100000 (757/760600) and 62.32/100000 (474/760600) in 2022, showing an annually decline trend ($\chi_{\text {trend}}^{2}$=47.824, P=0.000; $\chi_{\text {trend}}^{2}$=28.020, P=0.000). However, the notification rates of pulmonary tuberculosis and the pathogenic positive patients with ≥65 years accounted for 40.84% (3155/7725) and 45.90% (2049/4464) of the total tuberculosis patients, respectively, which increased from 36.06% (864/2396) and 41.45% (543/1310) in 2019 to 45.49% (757/1664) and 50.64% (474/936) in 2022, respectively, indicating an annualy increasing trend ($\chi_{\text {trend}}^{2}$=56.440, P=0.000; $\chi_{\text {trend}}^{2}$=23.053, P=0.000). From the clinical features perspective, the proportion of female, etiological positive, retreatment category and referral among elderly patients ≥65 years old were 53.44% (1686/3155), 64.94% (2049/3155), 6.59% (208/3155) and 76.89% (2426/3155), respectively, which were higher than those of patients <65 years old, respectively, accounting for 40.02% (1829/4570), 52.84% (2415/4570), 5.08% (232/4570) and 74.00% (3382/4570) (χ2=135.495, P=0.000; χ2=138.402, P=0.000; χ2=7.987, P=0.005; χ2=99.856, P=0.000). From the regional distribution, the proportion pulmonary tuberculosis with ≥65 years old with was higher in Zhongwei, Wuzhong and Shizuishan (47.78% (731/1530), 46.55% (783/1682) and 44.16% (367/831), respectively). In Shizuishan, the proportion increased from 37.55% (95/253) in 2019 to 52.02% (90/173) in 2022 with an annually increasing trend ($\chi_{\text {trend}}^{2}$=10.210, P=0.017). The proportions of elderly patients in Yinchuan and Guyuan were relatively lower (36.02% (857/2379) and 32.00% (417/1303), respectively). However, the proportions increased from 29.65% (223/752) and 26.21% (103/393) in 2019 to 41.30% (204/494) and 39.67% (119/300) in 2022, respectively, showing an increasing trend ($\chi_{\text {trend}}^{2}$=26.113, P=0.000; $\chi_{\text {trend}}^{2}$=17.234, P=0.001). From the perspective of occupational distribution, the proportion of farmer was higher (73.38% (2315/3155)), but decreased from 79.05% (683/864) in 2019 to 68.83% (521/757) in 2022. This was followed by household workers or unemployed and retirees (14.17% (447/3155) and 11.92% (376/3155), respectively). However, their share increased from 9.95% (86/864) and 10.42% (90/864) in 2019 to 17.57% (133/757) and 13.21% (100/757) in 2022. In terms of treatment outcome, the successful treatment rate of elderly tuberculosis patients (90.60% (2102/2320)) was statistically lower than that of patients <65 years (95.99% (3396/3538)) (χ2=70.394, P=0.000). The successful treatment rate of elderly patients increased from 88.28% (738/836) in 2019 to 92.31% (720/780) in 2021, showing an increasing trend ($\chi_{\text {trend}}^{2}$=8.605, P=0.014). Conclusion: From 2019 to 2022, the incidence of pulmonary tuberculosis in elderly patients aged ≥65 years old in Ningxia showed a decline trend, the proportion of elderly tuberculosis cases among whole tuberculosis cases showed an increasing trend. Therefore, health education and active screening of tuberculosis in spepcific populations, such as elderly women, etiological positive, retreatment, referral and follow-up, household worker, unemployed and retired people, and elderly patients in Shizuishan City, Yinchuan City and Guyuan City should be focused on to effectively reduce the tuberculosis epidemic in Ningxia.
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