Objective: To analyze the epidemiological characteristics and spatio-temporal clustering characteristics of pulmonary tuberculosis (PTB) among the elderly population in Zhuji City, Zhejiang Province from 2014 to 2024, so as to provide the evidence for formulating differentiated PTB prevention and control measures for the elderly population. Methods: Data of PTB cases aged ≥60 years in Zhuji City from 2014 to 2024 were collected from the Tuberculosis Management Information System of the China Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the distribution characteristics of PTB cases among the elderly population. The average annual percent change (AAPC) and annual percent change (APC) were used to analyze the trends in PTB registration rates among the elderly population from 2014 to 2024. Spatial autocorrelation analysis and spatio-temporal scan analysis were used to analyze the spatio-temporal clustering characteristics of PTB among the elderly population. Results: A total of 1 852 PTB cases aged ≥60 years were registered in Zhuji City from 2014 to 2024, with an average annual registration rate of 59.82/105, showing an overall declining trend (AAPC=-3.494%, P<0.05). The registration rate showed a downward trend from 2014 to 2020 (APC=-8.709%, P<0.05), while trend in the registration rate from 2020 to 2024 was not statistically significant (P>0.05). The majority cases were males and farmers, with 1 395 and 1 446 cases respectively, accounting for 75.32% and 78.08%. Spatial autocorrelation analysis showed that PTB among the elderly population showed spatial clustering distribution in 2015 and 2023, with Moran's I values of 0.249 and 0.323, respectively (both P<0.05). High-high clustering areas were predominantly located in estern and northern parts of the city, while low-low clustering areas concentrated in the southeastern area. Spatio-temporal scan analysis showed that there was one spatio-temporal clustering area of PTB among the elderly population, concentrated central, western, and northern regions of Zhuji City, with the clustering period spanning from April 2014 to September 2019. Conclusions The registration rate of PTB among the elderly population in Zhuji City from 2014 to 2024 showed an overall declining trend, with cases predominantly occurring among males and farmers. The clustered areas were mainly in the central, western, and northern parts of the city. It is recommended to strengthen PTB prevention and control for key populations in clustering areas.