Burden on the burdened: tuberculosis among Scheduled Tribes and non-Scheduled Tribes in constitutionally protected Scheduled and non-Scheduled areas of India

TL;DR

Scheduled Tribes in India face a higher tuberculosis burden than non-Tribes, with disparities persisting despite national declines in TB rates.

Contribution

This study quantifies TB disparities between Scheduled Tribes and non-Tribes in different constitutional district categories in India.

Findings

Scheduled Tribes had a significantly higher TB prevalence (416/100,000) compared to non-Tribes (277/100,000).

Tribal identity remained an independent risk factor for TB with an adjusted odds ratio of 1.47.

Non-Scheduled districts with >60% STs had the highest TB prevalence (608/100,000).

Abstract

India accounts for over a quarter of the global tuberculosis (TB) burden. Among the most affected are India’s Scheduled Tribes (STs) communities, experiencing a disproportionately higher TB prevalence compared to non-STs. Encouragingly, two successive rounds of National Family Health Survey (NFHS) showed the declined trend in overall TB prevalence in India, the rate of decline was markedly slower among STs, signalling that national gains have not translated into equitable progress. This study examines the point prevalence of TB and its determinants among STs and non-STs populations in constitutionally protected Scheduled and Non-Scheduled areas of India.

We analysed data from 2,077,924 individuals aged 15 and above from NFHS-5 (2019–2021) in India. Districts were stratified into: (1) Scheduled Area districts (with protections under Schedules V/VI), (2) non-Scheduled districts with > 60% STs, and (3) non-Scheduled districts with < 60% STs. We estimated TB point prevalence per 100,000 among STs and non-STs across these categories and examined associated socio-demographic, environmental, and behavioural factors. Multivariable logistic regression models assessed the adjusted odds of TB.

STs experienced significantly higher TB prevalence (416/100,000) than non-STs (277/100,000). This disparity persisted across all district categories. STs in Scheduled area districts had the lowest TB prevalence (330 per 100,000), while non-Scheduled districts with > 60% STs populations had the highest prevalence (608 per 100,000). Tribal identity remained an independent risk factor for TB [adjusted odd ratio (aOR) = 1.47; 95% confidence internal (CI) 1.38 −1.56], even after adjusting for covariates. Additional risk factors included older age, male sex, low household wealth, adverse household environments, tobacco and alcohol consumption, and hypertension and diabetes.

Tribal communities continue to shoulder a disproportionate TB burden, reflecting deep-rooted social and structural inequities. While constitutional protections in Scheduled Areas appear to offer some safeguards, disparities between STs and non-STs remain stark. Our findings serve as evidence and a call to action to ensure that tribal communities are at the forefront of TB control initiatives, so that the burden of TB is no longer borne disproportionately by those already burdened by socio-economic disadvantage.

The online version contains supplementary material available at 10.1186/s40249-025-01375-9.

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