To assess the tuberculosis (TB) epidemic and incidence trends in areas and countries along the Belt and Road Initiative, we analyzed the prevalence, diagnosis, and treatment of tuberculosis through consulting the data of the World Health Organization’s Global Tuberculosis Report. We estimated the tuberculosis incidence trends in these countries using joinpoint regression. Among the 65 countries along the route, in addition to Palestine with no relevant data, the incidence rate was 181.5 per 100,000, and the mortality rate was 23.1 per 100,000 in 2018. Both the incidence rates in 26 countries and the mortalities in 32 countries were higher than in China. Among the regions, the incidence and mortality of tuberculosis were the highest in South Asia, East Asia, and The Association of Southeast Asia Nations (ASEAN) countries, while the tuberculosis detection rate and positive bacteriological rate were the lowest in East Asia and ASEAN countries. Average yearly incidence decreased from 235.7 per 100,000 in 2004 to 181.5 per 100,000 in 2018 (average annual percentage change 1.9%) in these countries. Although TB incidence of most countries along the Belt and Road Initiative was declining, the rate of decrease was not yet fast enough. Therefore, it is essential to establish the exchange and cooperation mechanism of TB prevention and control experience among different countries, strengthen information com-munication and sharing, and explore a cross-border notification system. In addition, TB detection of interna-tional travelers should be carried out and improved.“,”To assess the tuberculosis (TB) epidemic and incidence trends in areas and countries along the Belt and Road Initiative, we analyzed the prevalence, diagnosis, and treatment of tuberculosis through consulting the data of the World Health Organization’s Global Tuberculosis Report. We estimated the tuberculosis incidence trends in these countries using joinpoint regression. Among the 65 countries along the route, in addition to Palestine with no relevant data, the incidence rate was 181.5 per 100,000, and the mortality rate was 23.1 per 100,000 in 2018. Both the incidence rates in 26 countries and the mortalities in 32 countries were higher than in China. Among the regions, the incidence and mortality of tuberculosis were the highest in South Asia, East Asia, and The Association of Southeast Asia Nations (ASEAN) countries, while the tuberculosis detection rate and positive bacteriological rate were the lowest in East Asia and ASEAN countries. Average yearly incidence decreased from 235.7 per 100,000 in 2004 to 181.5 per 100,000 in 2018 (average annual percentage change 1.9%) in these countries. Although TB incidence of most countries along the Belt and Road Initiative was declining, the rate of decrease was not yet fast enough. Therefore, it is essential to establish the exchange and cooperation mechanism of TB prevention and control experience among different countries, strengthen information com-munication and sharing, and explore a cross-border notification system. In addition, TB detection of interna-tional travelers should be carried out and improved.