Abstract： Objective:To explore the main risk factors of multidrug-resistant tuberculosis (MDR-TB) in China and to provide evidence-based evidence for MDR-TB preventon and control.Methods:All relevant literatures were searched in thedatabases, such as Pubmed, Web of Science and CNKI, Wanfang, VIP and SinoMed from 2000 to 2021. Quality evaluation and data extraction were carried out, and then a meta-analysis was performed using Stata 16.0 software.Results:A total of 59 literatures (36 cross-sectional and 23 case-control) including 75 793 participants were included in this study, and meta-analysis results showed age ( OR=1.27, 95% CI: 1.05-1.54), education level ( OR=1.29, 95% CI: 1.02-1.65), positive sputum smear ( OR=2.56, 95% CI: 1.09-6.04), pulmonary cavity ( OR=1.99, 95% CI: 1.57-2.52), course of disease ( OR=4.25, 95% CI: 1.95-9.30), history of tuberculosis treatment ( OR=6.42,95% CI:5.40-7.63), treatment interruption ( OR=2.81, 95% CI: 1.50-5.29), irregular medication ( OR=5.02, 95% CI: 2.95-8.54), adverse drug reactions ( OR=4.27, 95% CI: 2.22-8.19), combined chronic obstructive pulmonary disease (COPD) ( OR=2.21, 95% CI: 1.45-3.37), tuberculosis exposure history ( OR=1.99, 95% CI: 1.36-2.91), smoking history ( OR=1.35, 95% CI: 1.09-1.66) and floating population ( OR=1.60, 95% CI: 1.04-2.44) were associated with the occurrence of MDR-TB. Conclusions:The high risk groups were farmer, low education level, pulmonary cavity, long course of disease, history of tuberculosis treatment, treatment interruption, irregular medication, adverse drug reaction, co-COPD, contact history of tuberculosis, smoking history, rural residence, and floating population. We should pay attention to high-risk groups, strengthen management and take effective measures such as early screening, knowledge education on tuberculosis, standardized and personalized treatment and whole-course supervision.