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Objective: To analyze the prevalence of pulmonary tuberculosis (TB) in students in Shaanxi Province from 2015 to 2023 and identify influencing factors of adverse outcomes. Methods: The prevalence data of pulmonary TB in students in Shaanxi from 2015 to 2023 were derived from the TB subsystem of Chinese Disease Prevention and Control Information System. Software Joinpoint 5.4.0 was used to analyze the changing trends of the registration rate of pulmonary TB in students and the composition ratio of the TB patients in different age groups. Multivariate logistic regression model was used to identify influencing factors of adverse outcomes of pulmonary TB in students. Results: From 2015 to 2023, a total of 10 347 pulmonary TB cases were registered in students in Shaanxi, in which the cases in boy students accounted for 61.02% and the cases in students with education level at or above senior high school accounted for 79.06%. The cases were mainly distributed in Yan'an , Ankang, Shangluo and Yulin with average annual registration rates of 26.12/100 000,25.55/100 000,23.33/100 000 and 20.11/100 000 respectively. The registration rate increased from 19.36/100 000 in 2015 to 28.01/100 000 in 2018, and then declined to 9.90/100 000 in 2023 [annual percentage change (APC)=14.90%, 95%CI: 1.34%-30.27%; APC=-20.45%, 95%CI:-24.20% - -16.52%], showing an overall downward trend [average annual percentage change=-8.69%, 95%CI: -12.23% - -5.02%]. The results of multivariate logistic regression analysis showed that the risk factors for adverse outcomes of pulmonary TB in students included being in other ethnic groups (aOR=4.43,95%CI: 2.36-8.30) and living in Southern Shaanxi (aOR=1.51,95%CI: 1.12-2.02), living in Northern Shaanxi (aOR=1.73,95%CI: 1.33-2.24), floating population (aOR=1.58,95%CI: 1.26-1.98), being positive in etiology (aOR=1.28,95%CI: 1.01-1.61), no etiological result (aOR=4.06,95%CI: 2.68-6.17), self-medication or family management (aOR=2.46,95%CI: 1.29-4.71), using no fixed-dose combination (FDC)(aOR=2.21,95%CI: 1.75-2.80). Conclusions: From 2015 to 2023, the registration rate of pulmonary TB in students in Shaanxi showed an overall downward trend. Particular attention should be paid to the impact of factors such as other ethnic groups, the southern and northern regions of Shaanxi, migrant populations, positive bacteriology, no bacteriological results, self-medication or management by family members, and non-use of FDC on the unfavorable outcomes of student pulmonary tuberculosis.