BACKGROUND: Tuberculosis remains a major public health challenge worldwide. This study aimed to determine the long-term trends in the notification rate of tuberculosis in Zhejiang Province, and to assess the potential independent risks associated with age, time period, and birth cohort. METHODS: Data on all pulmonary tuberculosis (PTB) cases in Zhejiang Province from 2008 to 2022 were collected from the Tuberculosis Information Management System. Long-term trends in the notification rate and independent risks associated with quantitatively decomposed variables were determined using joinpoint regression model and age-period-cohort model. RESULTS: Between 2008 and 2022, a total of 323,745 PTB cases were notified in Zhejiang Province. Overall, the notification rate declined, with notable turning points in 2010 and 2019. Net drift analysis revealed an average annual decrease of 5.7% (95% CI: -6.8%, -4.6%
P <
0.01), with faster declines among males than females. Age effects showed peaks in notification rates among people aged 15-29 and 65-74. Period effects peaked during 2008-2012 (RR = 1.4
95% CI: 1.3, 1.5
P <
0.01). Cohort effects indicated decreasing risks in later birth cohorts, with the highest risk observed in the 1928-1932 birth cohort (RR = 11.0, 95% CI: 7.2, 16.8
P <
0.01) and relative protective effects in cohorts born after 1978-1982. CONCLUSIONS: Notification rates of PTB declined consistently across various age groups in Zhejiang Province. Young individuals aged 15-29 and older individuals aged 65-74 were identified as high-risk groups requiring active intervention. Additionally, pre-1978 birth cohorts had a relatively higher risk of PTB. These findings provided valuable insights into the age, period, and birth cohort characteristics of patients with PTB in Zhejiang Province, aiding relevant authorities in formulating appropriate policies and implementing targeted preventive control measures.