Treatment outcomes and risk factors for unfavorable results among older asymptomatic pulmonary tuberculosis patients in China, 2021-2024.

To understand the treatment outcomes and factors influencing unfavorable outcomes in older asymptomatic pulmonary tuberculosis patients (aPTB) in China, compare them with symptomatic patients, so as to provide a reference for further efforts in the prevention and treatment of asymptomatic tuberculosis in older people. Data on older patients with asymptomatic pulmonary tuberculosis registered between 2021 and 2024 were obtained from the China Disease Prevention and Control Information System, including demographic characteristics, clinical features, and treatment management information. Descriptive epidemiological methods were employed to analyze the characteristics and treatment outcomes of the patients, and logistic regression models were used to identify factors influencing unfavorable treatment outcomes. Comparisons were also made with symptomatic patients during the same period. Asymptomatic patients accounted for 11.54% (25,735/223,014). Treatment success rates were comparable between aPTB and symptomatic pulmonary tuberculosis (sPTB) groups (90.83% vs. 90.55%, P = 0.142). However, among patients with unfavorable outcomes, aPTB patients had higher loss to follow-up (18.52% vs. 13.69%) and not evaluated rates, while sPTB patients had higher mortality (76.87% vs. 72.15%) and treatment failure. Independent risk factors for unfavorable outcomes in aPTB included advanced age (≥ 80 years: AOR = 3.30), western residence (AOR = 1.38), pathogen-positivity (AOR = 1.35), comorbidities (AOR = 1.72), retreatment (AOR = 1.27), non-standard regimens (AOR up to 1.81), non-use of fixed-dose combinations (AOR = 1.18), no initial follow-up visit (AOR = 1.80), and adverse drug reactions (AOR = 6.58). Active case finding (AOR = 0.64) and high adherence (AOR = 0.02-0.06) were associated with lower odds of unfavorable outcomes. Older aPTB patients constitute a notable proportion with treatment success comparable to sPTB patients, but exhibit distinct patterns of unfavorable outcomes. Multiple factors (such as advanced age ≥ 80 years, comorbidities, adverse drug reactions, and non-standard regimens) were associated with unfavorable outcomes within this surveillance cohort, supporting targeted interventions for this overlooked population.