Tobacco, alcohol use and self-reported tuberculosis in India: Evidence from NFHS-5

Background: Tuberculosis (TB) remains a major public health challenge in India, with persistent socio-economic inequalities influencing exposure and vulnerability. This study examined the association between current tobacco and alcohol use and self-reported TB among Indian adults and assessed the confounding and effect-modifying role of socio-economic status measured by the household wealth index.

Methods: A cross-sectional analytical study was conducted using nationally representative data from the National Family Health Survey 2019–21. The analysis included 1,923,384 adults aged ≥18 years from the household member file. Logistic regression models were fitted sequentially to estimate crude and adjusted Odds Ratios (ORs/aORs) with 95% Confidence Intervals (CIs). Models adjusted for demographic, socio economic,environmental, and health-related covariates. Effect modification between substance use and wealth index was examined using adjusted Wald statistics. Sub-analyses involving Body Mass Index (BMI) and comorbidities were restricted to participants with biomarker data. Analyses were performed using STATA version 17, accounting for survey design and sampling weights.

Results: The weighted prevalence of self-reported TB was 1.1%. Adjusted analysis showed that both tobacco use (aOR 1.25, 95% CI 1.21–1.40) and alcohol consumption (aOR 1.20, 95% CI 1.00–1.44) remained significantly associated with higher odds of self-reported tuberculosis. Higher odds of TB were observed among individuals in the poorest wealth quintile, those with no schooling, living in kuccha housing, without electricity, and in large households. Diabetes, hypertension, and underweight BMI were also significantly associated with TB. Interaction analysis demonstrated that wealth modified the tobacco–TB association, with stronger relative effects observed in higher wealth quintiles (p for trend = 0.009).

Conclusion: Tobacco and alcohol use were independently associated with tuberculosis risk among Indian adults. Wealth-related effect modification reveals socio-economic gradients in vulnerability. Integrating substance-use cessation with structural and equity-focused interventions is essential to reduce TB burden and achieve India’s End TB 2030 targets.

Anusha Sreejith is an assistant professor in the department of community medicine at Gulf Medical University, Ajman, UAE. She teaches biostatistics, epidemiology, demography, and research methodology to undergraduate and postgraduate students and serves as the program director of the Master in Public Health (MPH) program. Her research interests include epidemiology, public health, non-communicable diseases, infectious diseases, medical education, and the application of artificial intelligence in healthcare research. She has authored several peer-reviewed publications and actively supervises graduate research. Sreejith is proficient in statistical analysis using spss and stata and is actively involved in curriculum development, accreditation, and community engagement initiatives.