Introduction: Tuberculosis (TB) patient delay, i.e., the duration from the onset of symptoms to the time of TB diagnosis is one of the issues in TB prevention and control in Japan, where Universal Health Coverage (UHC) has been achieved decades ago. We studied the trends and risk factors for patient delay by three categories, namely short (less than 2 months), medium (more than 2 months and less than 6 months) and long (longer than 6 months)-delay, and discussed implications for social protection measures. Methods: A descriptive cross-sectional study was conducted by analyzing the Japanese TB surveillance data of symptomatic pulmonary TB (PTB) cases registered between 2007 and 2017 (n = 88351). Results: While the number of patients with short delay has decreased significantly, of those with medium and long delay have shown very modest decrease. In fact, the proportion of those with medium delay has steadily increased, from 14.3% in 2007 to 17.0% in 2017. Not having health insurance, receiving social welfare, temporary workers, and history of homelessness were some of the risks identified for patient delay. Male gender and being a full-time worker were two risks specifically associated with long delay. Discussion