Abstract: Objective This study aimed to examine the patient delay status and associated factors among Tibetan pulmonary tuberculosis (PTB) patients in Qinghai Province, China, to provide a basis for optimizing tuberculosis prevention and control strategies for this population. Methods Data were obtained from the Tuberculosis Management Information System, a subsystem of Chinese Center for Disease Control and Prevention Information System, for all Tibetan PTB cases registered in Qinghai between 2013 and 2023. Compare differences in patient-delay rates across subgroups, and multivariate logistic regression was applied to identify factors influencing patient delay. Results A total of 23 868 Tibetan PTB cases were included in this study, among which 11 492 cases experienced patient delay, with a delay rate of 48.15% (11 492/23 868). The median delay duration was 14(4, 35) days. From 2013 to 2023, the patient-delay rate has shown a significant downward (χ2 trend=395.226, P<0.001). This downward trend was consistent in both male (χ2 trend=223.946, P<0.001) and female patients (χ2 trend=174.259, P<0.001). Multivariate analysis identified that older age≥21 years (OR=1.194, 95%CI:1.101-1.294), ≥41 years (OR=1.212, 95% CI: 1.107-1.328), ≥61 years (OR=1.195, 95%CI: 1.070-1.333), occupation as farmer (OR=1.218, 95% CI: 1.103-1.345), herdsman (OR=1.265, 95%CI: 1.157-1.383), or other occupations (OR=1.203, 95%CI: 1.085-1.347), case source being referral (OR=1.629, 95%CI: 1.223-2.171) or other sources (OR=2.055, 95%CI: 1.459-2.893), and retreatment classification (OR=1.165, 95%CI: 1.033-1.315) were risk factors for patient delay. Bacteriologically positive (OR=0.736, 95%CI: 0.664-0.816) and negative results (OR=0.642, 95%CI: 0.582-0.708) were protective factors against patient delay. Conclusions Although the patient-delay rate among Tibetan PTB patients in Qinghai has decreased in recent years. However, enhanced interventions, such as health education and social support for middle-aged and elderly populations, farmers, and herdsmen are still needed. Strengthening the capacity of designated TB hospitals at the primary level is also essential to encourage early seeking of care and further reduce patient delay.