Pneumology - Original Articles Open access

Sociodemographic, behavioral, and life-course risk factors for tuberculosis in older Indian adults: evidence from a nationally representative survey

Authors

Published
3 September 2026
Issue
Early Access
Section
Pneumology - Original Articles
DOI
10.4081/monaldi.2026.3825

Abstract

While tuberculosis (TB) propagation is multifactorial, the intersection of biological vulnerability (undernutrition) and cumulative life-course adversities is increasingly recognized as a crucial modifiable determinant. This study aimed to identify the independent biological, socioeconomic, behavioral, and life-course determinants of self-reported TB prevalence among middle-aged and older adults in India. We conducted a cross-sectional analysis using Wave 1 of the Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample included 59,910 adults aged 45 years and above with non-missing data on TB status and body mass index. The outcome was a self-reported TB diagnosis within the preceding 2 years. Survey-weighted logistic regression was used to examine factors associated with self-reported TB. Firth bias-reduced logistic regression was performed as a sensitivity analysis because of the low prevalence of self-reported TB. Overall, 550 participants (0.92%) reported TB within the preceding two years. Undernutrition was more common among participants with self-reported TB than among those without TB. In adjusted survey-weighted models, undernutrition, history of being bedridden for 1 month or more during childhood, multimorbidity, and residence in the Western region were independently associated with higher odds of self-reported TB. The findings were broadly consistent in the Firth bias-reduced sensitivity analysis. TB prevalence in older Indian adults is independently driven by undernourishment and the cumulative impact of early-life disease/deprivation, alongside the burden of multimorbidity. These findings underscore the need for the National TB Elimination Program to strengthen nutritional support and integrate TB prevention with comprehensive geriatric care and robust pediatric health investments to reduce adult vulnerability.

Keywords

Ethics Approval

This study is a secondary data analysis of de-identified data from the publicly accessible Longitudinal Aging Study in India Wave-1 dataset. The original survey participants voluntarily provided signed informed consent, and the survey protocol received approval (LASI/12/1054) from the Institutional Review Board at the International Institute for Population Sciences (IIPS), Mumbai and the Indian Council of Medical Research, New Delhi.

References

  1. World Health Organization. Global Tuberculosis Report 2024. Available from: https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024.
  2. Central TB Division. India TB report 2024. Available from: https://tbcindia.mohfw.gov.in/wp-content/uploads/2024/10/TB-Report_for-Web_08_10-2024-1.pdf.
  3. Bhargava A, Bhargava M, Juneja A. Social determinants of tuberculosis: context, framework, and the way forward to ending TB in India. Expert Rev Respir Med 2021;15:867-83. DOI: https://doi.org/10.1080/17476348.2021.1832469
  4. Padmapriyadarsini C, Shobana M, Lakshmi M, et al. Undernutrition & tuberculosis in India: situation analysis & the way forward. Indian J Med Res 2016;144:11-20. DOI: https://doi.org/10.4103/0971-5916.193278
  5. Saunders MJ, Cegielski JP, Clark RA, et al. Body mass index and tuberculosis risk: an updated systematic literature review and dose-response meta-analysis. Int J Epidemiol 2025;54:dyaf154. DOI: https://doi.org/10.1093/ije/dyaf154
  6. Hargreaves JR, Boccia D, Evans CA, et al. The social determinants of tuberculosis: from evidence to action. Am J Public Health 2011;101:654-62. DOI: https://doi.org/10.2105/AJPH.2010.199505
  7. Bates MN, Khalakdina A, Pai M, et al. Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis. Arch Intern Med 2007;167:335-42. DOI: https://doi.org/10.1001/archinte.167.4.335
  8. Imtiaz S, Shield KD, Roerecke M, et al. Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease. Eur Respir J 2017;50:1700216. DOI: https://doi.org/10.1183/13993003.00216-2017
  9. Thomas BE, Thiruvengadam K, S R, et al. Smoking, alcohol use disorder and tuberculosis treatment outcomes: a dual co-morbidity burden that cannot be ignored. PLoS One 2019;14:e0220507. DOI: https://doi.org/10.1371/journal.pone.0220507
  10. Balinda IG, Sugrue DD, Ivers LC. More than malnutrition: a review of the relationship between food insecurity and tuberculosis. Open Forum Infect Dis 2019;6:ofz102. DOI: https://doi.org/10.1093/ofid/ofz102
  11. Ayiraveetil R, Sarkar S, Chinnakali P,et al. Household food insecurity among patients with pulmonary tuberculosis and its associated factors in South India: a cross-sectional analysis. BMJ Open 2020;10:e033798. DOI: https://doi.org/10.1136/bmjopen-2019-033798
  12. Wagnew F, Gray D, Tsheten T, et al. Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review. Nutr Rev 2024;82:1216-25. DOI: https://doi.org/10.1093/nutrit/nuad120
  13. Sinha P, Lönnroth K, Bhargava A, et al. Food for thought: addressing undernutrition to end tuberculosis. Lancet Infect Dis 2021;21:e318-25. DOI: https://doi.org/10.1016/S1473-3099(20)30792-1
  14. Samuel B, Volkmann T, Cornelius S, et al. Relationship between nutritional support and tuberculosis treatment outcomes in west Bengal, India. J Tuberc Res 2016;4:213-9. DOI: https://doi.org/10.4236/jtr.2016.44023
  15. Marais BJ, Gie RP, Schaaf HS, et al. The clinical epidemiology of childhood pulmonary tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis 2004;8:278-85.
  16. Rajagopalan S. Tuberculosis in older adults. Clin Geriatr Med 2016;32:479-91. DOI: https://doi.org/10.1016/j.cger.2016.02.006
  17. Yew WW, Yoshiyama T, Leung CC, Chan DP. Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people. Respirology 2018;23:567-75. DOI: https://doi.org/10.1111/resp.13303
  18. Teo AKJ, Morishita F, Islam T, et al. Tuberculosis in older adults: challenges and best practices in the Western Pacific Region. Lancet Reg Health West Pac 2023;36:100770. DOI: https://doi.org/10.1016/j.lanwpc.2023.100770
  19. International Institute for Population Sciences (IIPS), National Programme for Health Care of Elderly (NPHCE), Ministry of Health and Family Welfare, Government of India. Longitudinal Ageing Study in India (LASI) Wave-1, India Report. Mumbai: International Institute for Population Sciences; 2020.
  20. LASI-DAD Study Collaborators. Harmonized (LASI-DAD) documentation. Version A.3. 2022. Available from: https://lasi-dad.org/codebooks/Harmonized%20LASI-DAD%20A.3.pdf
  21. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63. DOI: https://doi.org/10.1016/S0140-6736(03)15268-3
  22. Sharma N, Basu S, Chopra KK. Achieving TB elimination in India: the role of latent TB management. Indian J Tuberc 2019;66:30-3. DOI: https://doi.org/10.1016/j.ijtb.2018.10.006
  23. Chauhan A, Parmar M, Dash GC, et al. The prevalence of tuberculosis infection in India: A systematic review and meta-analysis. Indian J Med Res 2023;157:135-51. DOI: https://doi.org/10.4103/ijmr.ijmr_382_23
  24. Mandal S, Bhatia V, Bhargava A, et al. The potential impact on tuberculosis of interventions to reduce undernutrition in the WHO South-East Asian Region: a modelling analysis. Lancet Reg Health Southeast Asia 2024;31:100423. DOI: https://doi.org/10.1016/j.lansea.2024.100423
  25. Thomas T A. Tuberculosis in children. Pediatr Clin North Am 2017;64:893-909. DOI: https://doi.org/10.1016/j.pcl.2017.03.010
  26. Chauhan A, Parmar M, Rajesham JD, et al. Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India. BMC Public Health 2024;24:453. DOI: https://doi.org/10.1186/s12889-024-17828-z
  27. Jarde A, Romano E, Afaq S, et al. Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review. BMJ Open 2022;12:e060906. DOI: https://doi.org/10.1136/bmjopen-2022-060906
  28. Prasad V. 50 years of a nation-wide child development programme in India. BMJ Paediatr Open 2025;9:e003857. DOI: https://doi.org/10.1136/bmjpo-2025-003857
  29. Jeyashree K, Shanmugasundaram P, Shanmugasundaram D, et al. Direct benefit transfer for nutritional support of patients with TB in India-analysis of national TB program data of 3.7 million patients, 2018-2022. BMC Public Health 2024;24:299. DOI: https://doi.org/10.1186/s12889-024-17777-7
  30. Foe-Essomba JR, Kenmoe S, Tchatchouang S, et al. Diabetes mellitus and tuberculosis, a systematic review and meta-analysis with sensitivity analysis for studies comparable for confounders. PLoS One 2021;16:e0261246. DOI: https://doi.org/10.1371/journal.pone.0261246

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