Background <p>Tuberculosis (TB) continues to pose a significant public health challenge, particularly among the elderly population. To address this issue, a large-scale TB screening initiative was conducted in Jiangshan City, focusing on individuals aged 65 and older.</p> Methods <p>This study conducted comprehensive screening of 72,716 elderly participants to identify TB cases. Demographic data were meticulously analyzed, and multivariate analysis was used to determine factors associated with TB. The number needed to screen (NNS) was calculated across different conditions to evaluate the cost-effectiveness of screening implementation in various risk groups.</p> Results <p>During the study period, a total of 187&#xa0;TB cases were diagnosed, with a prevalence of 257 cases per 100,000 population. The NNS to detect one TB case was 389 among all participants, with variations observed across different risk subgroups. Males, individuals with a BMI &lt; 18.5, and those with a history of TB were identified as high-risk populations. Furthermore, differences in blood biochemical parameters were identified between TB patients and healthy individuals, with TB patients demonstrating slightly elevated platelet counts and lower total cholesterol levels.</p> Conclusion <p>This study provides exploratory findings on the implementation of population-wide active TB screening among elderly individuals, with a non-statistically significant 10% increase in case detection compared with conventional passive surveillance systems (1.10, 95% CI: 0.85–1.43). Among male participants, the observed detection rate ratio was 1.30 (95% CI: 0.96–1.76, non-statistically significant). Our results identify three demographic and clinical parameters — male sex, poor nutritional status, and a history of previous TB — that showed cross-sectional associations with TB detection in this screening setting, suggesting they may warrant further investigation for potential inclusion in future screening protocols.</p> Clinical trial <p>Not applicable.</p>