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BACKGROUND: Tuberculosis (TB) is among the top 10 causes of global death, and patient delay is a key factor causing higher mortality. This study intends to analyze the associated factors with TB patient delay. METHODS: Embase, Cochrane Library, PubMed, and Web of Science were systematically searched for online available studies and unpublished sources from inception to 2025. STATA15.1 was adopted for data analyses, heterogeneity by inverse variance (I 2) and Cochran's Q-tests, and publication bias by Egger's tests. The Newcastle-Ottawa Scale was utilized for assessing the quality of cohort and case-control studies, and the Agency for Healthcare Research and Quality criteria for cross-sectional studies. RESULTS: Forty-two studies were included, involving 492,448 patients. The meta-analysis showed that occupation (OR 1.20, 95% CI 1.10-1.30, p < 0.001), educational level (OR 1.37, 95% CI 1.007-1.76, p = 0.012), place of residence (OR 1.66, 95% CI 1.44-1.92, p < 0.001), TB classification (OR 1.31, 95% CI 1.15-1.49, p < 0.001), diabetes (OR 0.62, 95% CI 0.47-0.81, p < 0.001), HIV infection (OR 0.80, 95% CI 0.72-0.89, p = 0.032), drinking (OR 1.43, 95% CI 1.29-1.59, p < 0.001), TB knowledge (OR 2.09, 95% CI 1.61-2.71, p < 0.001), stigma (OR 1.87, 95% CI 1.48-2.36, p < 0.001), and time of arrival at health services (OR 1.34, 95% CI 1.03-1.74, p = 0.03) were closely associated with patient delay. Age, sex, marital status, BMI, insurance, smoking, knowing someone with TB, and distance to health services had no associations with patient delay. CONCLUSION: Patient delay not only affects the treatment and prognosis but also worsens the burden on the family and society. The rate of patient delay can be reduced by strengthening health education, establishing a perfect service system, and implementing early screening.