Background/Aim. Tuberculosis (TB) incidence has declined substantially in Europe over recent decades. However, demographic shifts and health disruptions such as the coronavirus disease-19 – COVID-19 pandemic continue to influence TB epidemiology. In the Republic of Serbia, long-term subnational analyses remain limited. The aim of the study was to analyze trends in TB incidence, mortality, demographic characteristics, and seasonality in the Autonomous Province (AP) of Vojvodina, Serbia, over 28 years. Methods. A descriptive, population-based study was conducted using routinely collected surveillance data from 1998 to 2025. TB cases were identified according to national case definitions aligned with World Health Organization and European Center for Disease Prevention and Control standards. Occupational data for TB cases among workers were available for the period 2015–2025. Results. A total of 9,511 TB cases were reported (mean 339.7 annually). Joinpoint regression analysis demonstrated a significant overall decline in TB incidence (average annual percent change – AAPC = -5.73%; 95% confidence interval: -7.31 to -4.02; p < 0.001), primarily driven by a marked annual decrease between 2002 and 2021, followed by a non-significant increase in incidence during the final study period. A total of 226 deaths were recorded. Mortality remained low (0.00–0.98 per 100,000), with no deaths recorded in 2020–2021. TB incidence and mortality showed a pronounced age gradient, with the highest rates in individuals aged ≥ 60 years, while pediatric TB was nearly eliminated. The proportions of older patients, laboratory-confirmed cases, and fatal outcomes compared to survivors were all significantly higher in 2012–2025 than in 1998–2011. A consistent seasonal pattern was observed, with peak case notifications in January (22% of all reported cases). A total of 21 sporadic TB cases were identified among workers during 2015–2025, distributed across various occupational groups, mainly among middle-aged males. Conclusion. TB burden in the AP of Vojvodina has declined markedly, but an increasing proportion of TB cases among older adults was recorded. Although rare, TB cases among workers occurred across diverse occupational groups, underscoring the need for continued occupational surveillance.