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Background The tuberculosis (TB) epidemic remains a public health concern, with TB as the leading infectious cause of death globally. Despite effective antimicrobial treatment, significant morbidity and mortality remains, even after biological cure. Pneumonia is common in post-TB patients but its risk has not yet been quantified at a population level. We present a population-based cohort study investigating rate of hospital admission for pneumonia amongst patients following TB diagnosis compared to matched people without TB.Methods Data was taken from UK primary care and linked hospital admissions between 2000-2019. We matched adults with TB (n=17,428) with up to 10 people without TB based on age, sex, ethnicity, and GP practice. Participants and their matched controls were followed from 90 days - 5 years post-TB diagnosis. Poisson models estimated incident rate ratios (IRR) for pneumonia admissions (identified by ICD-10 codes) in people with TB compared to those without.Results People with prior TB were four times more likely to be admitted to hospital with pneumonia than those without a history of TB (IRR = 4.0, 95% CI = 3.6-4.4). This risk remains after adjusting for major confounders such as deprivation, BMI, smoking, HIV status, respiratory co-morbidities (asthma and COPD), diabetes and previous pneumonia admissions (IRR 3.1, CI = 2.7-3.4). Higher relative risks of pneumonia were seen among individuals aged 50–64 years (IRR 4.2, CI = 3.4-5.3) and those without a recorded pneumococcal vaccination (IRR 4.5, CI = 3.7-5.6). The elevated risk in adults aged 50-64 years may reflect lower vaccination coverage, as routine pneumococcal immunisation is recommended from age 65.Conclusion Our study raises awareness of the high relative risk of pneumonia in post-TB patients up to 5 years post-diagnosis. Currently, people with a history of TB are not routinely vaccinated against pneumonia, highlighting the potential for protection through vaccination in post-TB disease management.