Investigating the geographic linkage between airborne pollutants and tuberculosis rates in India

Abstract

Recent satellite observations indicate sustained deterioration in ambient air quality across Indian urban and rural regions. In India, nearly 30 people die from tuberculosis every day, a toll that exceeds the average daily COVID-19 deaths observed during the first wave of the pandemic. This study investigates the spatial associations among airborne pollutants, eco-hydrological driver and tuberculosis (TB) incidence and mortality across India’s states based on remote sensing and health data. High-resolution Sentinel-5P satellite quantified concentrations of air pollutants (PM₁₀, NO₂, SO₂, O₃, and HCHO), alongside MODIS-derived NDVI, LST, and precipitation data for 2022 as well as TB data collected from report of MFHW 2022. Spatial distribution analysis revealed pronounced geographic clustering, with northern and central states (Uttar Pradesh, Madhya Pradesh, and Bihar) exhibiting the highest convergence of elevated TB burden, poor air quality, and reduced vegetation cover. Statistical analyses found TB incidence was positively linked to air pollution (coefficient 1.98, p < 0.002), formaldehyde (r = 0.286), and land surface temperature (r = 0.218). More vegetation cover was strongly protective against both TB incidence (coefficient − 5.73, p < 0.002) and mortality (coefficient − 4.62, p < 0.02). Population density significantly predicted TB mortality (coefficient 1.72, p < 0.001). These findings establish a compelling environmental epidemiological framework linking air quality degradation to TB transmission and outcomes in India. The results suggest that environmental remediation strategies, including air pollution control and urban vegetation enhancement should be integrated with conventional biomedical TB control programs. This integrated approach aligns with India’s National TB Elimination Programme goals while contributing to broader respiratory health improvements and environmental sustainability objectives. © The Author(s) 2025.