Abstract Background Although increasing evidence suggests an association between particulate matter (PM) and tuberculosis (TB), epidemiological studies in southern China remain limited. Methods Daily tuberculosis (TB) case numbers, air pollution, and meteorological data for four cities (Guangzhou, Shenzhen, Foshan and Jiangmen) in southern China during 2015–2019 were collected. A two-stage analytical approach was used to evaluate the association between PM and TB incidence, with stratification by sex, age, disease severity, and city. Results A total of 101,567 TB cases were reported in four cities. The relationships between PM 2.5 and PM 10 and TB incidence were approximately linear, with the highest risk observed at a cumulative lag of 0–2 days (lag02). Each 10ug/m 3 increase in PM 2.5 was associated with a 0.84% (95%CI: 0.28%,1.41%) increase in TB incidence, which exceeded the corresponding risk for PM 10 (0.71%, 95%CI: 0.26%, 1.15%). The effect of PM 10 and PM 2.5 on TB incidence appeared to be greater among females, younger individuals, patients with non-severe TB, and residents of Guangzhou and Shenzhen. Conclusions Short-term exposure to ambient PM may significantly increase TB incidence risk in southern China. These findings provide scientific evidence to support the development of integrated TB prevention and air quality management strategies. Clinical trial number Not applicable.

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