Abstract: OBJECTIVE To investigate the characteristics of elderly patients with asymptomatic pulmonary tuberculosis (aPTB) in China under the patterns of active finding and passive finding from 2021 to 2024 so as to provide bases for optimizing the prevention and control strategies for tuberculosis among the elderly population. METHODS The data were collected from the patients with aPTB who were no less than 65 years of age and were registered in China Disease Prevention and Control Information System from Jan. 1, 2021 to Dec. 31, 2024. The number of detected cases, sources, spectra of symptoms and characteristics of patients were observed and compared between the two finding patterns. The temporal and regional distributions of the detected cases were described. RESULTS The proportion of the elderly patients with aPTB was 26.15% under the active finding pattern, higher than 11.67% under the passive finding pattern. The patients who were detected under the active finding pattern were primarily identified through routine physical examinations (78.51%), whereas the patients who were detected under the passive finding pattern relied mainly on referrals (49.89%) and tracing (29.84%). Regarding the symptom spectra, the detected patients who were completely asymptomatic accounted for 78.68% under the active finding pattern and only accounted for 35.75% under the passive finding pattern. There were significant differences in the sex, age, diagnosis result, result of sputum smear, complications, drug resistance status and treatment history between the two groups (all P＜0.001). In term of the temporal distribution, the patients who were detected under the active finding pattern concentrated in March and April, while the patients who were detected under the passive finding pattern concentrated in July and August. With the respect to regional distribution, the percentage of the patients who were detected under the active finding pattern was highest in Xinjiang Uygur Autonomous Region (46.66%, 937 cases); the percentage of the patients who were detected under the passive finding pattern was (202 cases,99.51%) in Gansu Province, (1 995 cases,98.91%) in Guangxi Zhuang Autonomous Region. CONCLUSIONS The active finding pattern is superior to the passive finding pattern in detection of the elderly patients with aPTB, with the detected patients presenting less severe clinical symptoms. The active finding capacity varies remarkably among the regions. It is necessary to intensify the active screening of tuberculosis for the elderly population in China and boost the capacity of finding the hidden infectious sources.