Tuberculosis and Associated Vulnerabilities Among Rural Residents in Jaipur District, Rajasthan, India: A Community-Based Cross-Sectional Study

<title>Abstract</title> <p>Background Tuberculosis (TB) remains a major public health challenge in India, particularly among rural populations with overlapping biological, behavioural, and occupational vulnerabilities. This study estimated the burden of self-reported TB and examined the independent and cumulative effects of selected vulnerability factors in rural Rajasthan. Methods A community-based cross-sectional study was conducted among 13,122 residents from eight villages in Jaipur district, Rajasthan. Socio-demographic characteristics, self-reported TB, and potential vulnerability factors were collected through household surveys. Due to the rarity of TB events, Firth's bias-reduced logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). A pre-specified sensitivity analysis, Population Attributable Fractions (PAFs), and a composite vulnerability score were used to assess population-level burden and cumulative risk. Results The prevalence of self-reported TB was 0.09% (12/13,122) under the primary definition and 0.37% (49/13,122) under the sensitivity definition. Silicosis demonstrated the strongest independent association with TB (adjusted OR 47.38, 95% CI 7.38–304.18; sensitivity model adjusted OR 16.42, 95% CI 4.47–60.33). Under the sensitivity analysis, smoking (adjusted OR 4.14, 95% CI 1.87–9.18), diabetes (adjusted OR 4.40, 95% CI 1.06–18.30), and age &gt; 15 years (adjusted OR 8.73, 95% CI 1.73–44.04) were also independently associated with TB. Although silicosis conferred the highest individual risk, smoking accounted for the largest attributable fraction (≈ 14%). Increasing composite vulnerability scores were associated with progressively higher odds of TB, demonstrating a significant dose–response relationship. Conclusions In this rural community, self-reported TB was uncommon but was associated with several biological and behavioural vulnerabilities, particularly silicosis. The observed dose–response relationship between cumulative vulnerabilities and self-reported TB warrants further investigation in larger prospective studies. If confirmed, these findings could inform risk-based approaches for community TB screening in similar high-risk populations.</p>