Objective To understand the status and influencing factors of diagnostic delay in tuberculosis patients in Guangxi Zhuang Autonomous Region (abbreviated as Guangxi),and to provide reference for scientifically formulating tuberculosis prevention and control measures. Methods Data of tuberculosis patients registered from 2019 to 2024 in Guangxi were exported from the Tuberculosis Information Management System of the Chinese Disease Prevention and Control Information System,with a total of 207 027 patients included.The chi-square trend test was used to analyze temporal changes of delayed detection in patients with pulmonary tuberculosis,and multivariate logistic regression was employed to identify influencing factors. Results From 2019 to 2024,the diagnostic delay rate among tuberculosis patients in Guangxi was 54.36% (112 537/207 027),with a median delay time of 32 (14,70) days.The delay rate showed a decreasing trend from 2019 to 2022 (annual decrease rate: 0.30%,χ ${ }_{trend}^{2}$=76.132,P<0.001),but rebounded to 56.69% in 2023-2024.The delay rate was higher in males (54.91%) than in females (52.93%),and the delay rate was the highest in the 45-64 age group (57.17%).Farmers (56.91%) and unemployed/retired individuals (50.53%) had higher delay rates than those with stable occupations (43.81%).Fangchenggang (65.27%) and Qinzhou (63.93%) had the highest delay rates,but Qinzhou exhibited a significant annual decrease rate (1.94%).Multivariate logistic regression analysis revealed that compared to patients aged <24 years,those aged 45-64 (OR=1.158,95%CI:1.109-1.208) had a higher risk of diagnostic delay.Compared to patients with stable occupations,unemployed/retired individuals (OR=1.340,95%CI:1.277-1.406) and farmers (OR=1.499,95%CI:1.436-1.565) had higher risk of diagnostic delay,while students (OR=0.840,95%CI:0.784-0.901) had a lower risk of diagnostic delay.Compared to patients detected due to symptoms/recommendation,those identified through contact tracing (OR=1.152,95%CI:1.110-1.196) had a higher risk of diagnostic delay,while those diagnosed through referral (OR=0.876,95%CI:0.854-0.898) or health checkups/active screening (OR=0.380,95%CI:0.344-0.419) had lower risk of diagnostic delay.Compared to patients first diagnosed at autonomous region-level facilities,those first diagnosed at prefecture-level (OR=0.625,95%CI:0.606-0.646) or county (city,district) level (OR=0.875,95%CI: 0.848-0.902) institutions had lower risk of diagnostic delay.Compared to new patients,retreated patients (OR=1.196,95%CI:1.157-1.237) had higher risk of diagnostic delay. Conclusion The issue of diagnostic delay in tuberculosis patients in Guangxi is prominent,and enhanced the active screening for high-risk groups (aged 45-64,farmers,and retreated cases),are urgently needed.