Abstract: Pneumoconiosis represents the most devastating occupational disease in China, while pulmonary tuberculosis (PTB) stands as the most prevalent complication and the leading cause of death among pneumoconiosis patients. The comorbidity imposes a substantially heavier disease burden and socioeconomic impact. Since the release of findings from the 1949—1986 National Epidemiological Survey of Pneumoconiosis, nationwide large-population-based epidemiological data on pneumoconiosis complicated with pulmonary tuberculosis have been unavailable in China for nearly three decades. Based on a nationwide cross-sectional survey of 10 137 pneumoconiosis patients across 27 provinces, our team systematically analyzed the epidemiological patterns and risk factors of this comorbidity for the first time under the World Health Organization Commission on Social Determinants of Health (CSDH) framework. The overall prevalence of PTB in Chinese pneumoconiosis patients is 7.5% (95%CI: 7.0%–8.0%), a nearly 50% reduction compared with data from the 1980s, but remains at a relatively high level with pronounced urban-rural, regional and population disparities. Rural household registration, lack of work-related injury insurance and nosocomial TB exposure are the three top social structural factors by population attributable fraction. The coexistence of multiple risk factors can elevate PTB risk by more than 20-fold. In light of the current status of China’s pneumoconiosis and TB prevention and control systems, this paper proposes targeted precision prevention and control strategies from multiple dimensions, including integrated medical and preventive screening, nosocomial infection prevention and control, social security support, and whole-chain comprehensive intervention, to provide a scientific basis for optimizing the TB prevention and control system for occupational populations and advancing the End TB Strategy in China.

Key words: Pneumoconiosis, Tuberculosis, Pulmonary; Epidemiology, Social environment, Preventive medicine