{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:27:48Z","timestamp":1787570868389,"version":"build-2736575974"},"reference-count":41,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Indian Council of Social Science Research, New Delhi","award":["19\/LSS\/2024-1054\/HS&SP\/SCD Dated 23.09.2024"],"award-info":[{"award-number":["19\/LSS\/2024-1054\/HS&SP\/SCD Dated 23.09.2024"]}]},{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research, New Delhi","doi-asserted-by":"crossref","award":["01\/02\/2024"],"award-info":[{"award-number":["01\/02\/2024"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research, New Delhi","doi-asserted-by":"crossref","award":["Extramural\/Intermediate-DL\/2024\/07-02"],"award-info":[{"award-number":["Extramural\/Intermediate-DL\/2024\/07-02"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,30]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tea-tribe communities in Assam face a substantial and under-recognised burden of stroke, shaped by socioeconomic marginalisation, limited access to formal healthcare and distinct cultural practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We estimated the prevalence of physician-diagnosed stroke, described associated functional and psychological disabilities, characterised gaps in diagnosis and care, and developed a logistic regression-based classification score for prevalent stroke among tea-tribe adults in Cachar district, Assam, Northeast India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a community-based cross-sectional door-to-door survey (July 2024\u2013August 2025) across five tea estates among permanent tea-tribe residents aged \u226518 years. Trained community health workers collected data on sociodemographics, vascular risk factors, healthcare utilisation and poststroke functional and psychological outcomes using a structured questionnaire, the Modified Rankin Scale and a symptom inventory. Stroke was identified through community symptom screening and confirmed by teleconsultation with a senior neurologist, supported by neuroimaging where available. A multivariable logistic regression model with stepwise selection identified factors associated with prevalent stroke and regression coefficients were converted into an additive point-based classification score. Internal validation used 1000 bootstrap samples and a 70:30 train\u2013test split. The model performance was assessed using the area under the receiver operating characteristic curve and Brier score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3818 participants, 164 had a history of stroke (prevalence 4.3%), with a higher prevalence in older adults, men, unemployed or semiskilled or skilled workers and households below the poverty line. Hypertension was the strongest risk factor and its combination with daily tea containing added salt was associated with markedly higher odds of stroke. Alcohol consumption, smoking and previous heart disease were also associated with stroke. Stroke survivors had high functional and psychological burdens and fewer than half reached a health facility within 4.5 hours or underwent CT\/MRI. The final model showed good discrimination (area under the curve 0.84) and calibration (Brier score 0.037). The derived classification score (0\u201319 points) identified a highly associated group (scores &gt;13) with a stroke prevalence of 14.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The tea-tribe community in Assam faces a high stroke burden, substantial disability and major gaps in timely diagnosis and care. A simple, internally validated classification score based on demographic, socioeconomic and vascular factors may help target community screening and prevention but requires external validation and cautious interpretation given the cross-sectional design and self-reported exposures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114655","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:15:28Z","timestamp":1787570128000},"page":"e114655","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Burden, unmet healthcare and associated disabilities among people with prevalent stroke in tea-tribe communities of Cachar district, Assam state, Northeast India: a cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"given":"Vivek K","family":"Nambiar","sequence":"first","affiliation":[{"name":"Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subham","family":"Nunia","sequence":"additional","affiliation":[{"name":"Clinical Consultant, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazumder M","family":"Jubair","sequence":"additional","affiliation":[{"name":"Project Scientist-I, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthika","family":"Rani","sequence":"additional","affiliation":[{"name":"Head of Research, HCG Hospitals, Bengaluru, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shashank","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Consultant Neurologist, CARE Hospitals Group, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4906-7499","authenticated-orcid":false,"given":"Nishant","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divyasree","family":"Chandran","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Pashi","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradip","family":"Pashi","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masuma","family":"Khanam","sequence":"additional","affiliation":[{"name":"Research Associate and PhD Scholar, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjoy Kumar","family":"Singha","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mita","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishwarya","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assam University, Silchar, AS, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabarun","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Research Associate and PhD Scholar, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubhadeep","family":"Roychoudhury","sequence":"additional","affiliation":[{"name":"Department of Life Science and Bioinformatics, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shatabhisha","family":"Chakraborty Roychoudhury","sequence":"additional","affiliation":[{"name":"Health Centre, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun B","family":"Sukai","sequence":"additional","affiliation":[{"name":"Department of Social Work, Assam University, Silchar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilip","family":"Nath","sequence":"additional","affiliation":[{"name":"School of Applied and Pure Sciences, The Assam Royal Global University, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4486-632X","authenticated-orcid":false,"given":"Denny","family":"John","sequence":"additional","affiliation":[{"name":"Institute of Health Economics, Epidemiology & Translational Sciences (IHEETS), Thiruvalla, Kerala, India"},{"name":"School of Public Health, Adelaide University, Adelaide, South Australia, 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State wise\/region wise and month wise tea production for the year 2024. Available: https:\/\/teaboard.gov.in\/pdf\/State_Region_wise_tea_production_2024_and_2024_25_Apr_Dec_pdf4332.pdf [Accessed 28 May 2026]."},{"key":"2026082404152239000_16.8.e114655.8","first-page":"51","article-title":"Health concerns of tea workers in India","volume":"9","author":"Moitra","year":"2013","journal-title":"International Journal of Tea Science"},{"key":"2026082404152239000_16.8.e114655.9","doi-asserted-by":"crossref","unstructured":"Siddika A , Rai PK , Singh A . Leaf to life: an overview of the socio-economic status of tea tribes in assam. In: Natural resources management and sustainable livelihoods in the mountainous region: Evidence, gap and future strategies. 2024: 337\u201345.","DOI":"10.1007\/978-981-97-2100-9_20"},{"key":"2026082404152239000_16.8.e114655.10","unstructured":"Directorate of Economics and Statistics, Govt. of Assam . Morbidity status among tea garden workers of Assam. 2025. Available: https:\/\/des.assam.gov.in\/sites\/default\/files\/swf_utility_folder\/departments\/ecostat_medhassu_in_oid_3\/this_comm\/morbidity_status_among_tea_garden_workers_of_assam.pdf [Accessed 5 Oct 2025]."},{"key":"2026082404152239000_16.8.e114655.11","first-page":"543","article-title":"Stroke burden and risk factors among tribal populations in India: a systematic review","volume":"68","author":"Banerjee","year":"2020","journal-title":"Neurol India"},{"key":"2026082404152239000_16.8.e114655.12","first-page":"S10","article-title":"Vascular risk factors in tribal India: emerging evidence and public health implications","volume":"65","author":"Bhatnagar","year":"2021","journal-title":"Indian J Public Health"},{"key":"2026082404152239000_16.8.e114655.13","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.008918"},{"key":"2026082404152239000_16.8.e114655.14","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1016\/S0140-6736(17)32804-0","article-title":"Nations within a nation: variations in epidemiological transition across the states of India, 1990\u20132016 in the global burden of disease study","volume":"390","author":"Dandona","year":"2017","journal-title":"The Lancet"},{"key":"2026082404152239000_16.8.e114655.15","first-page":"1","article-title":"Making of tea tribes in Assam: Colonial exploitation and assertion of Adivasi rights","volume":"3","author":"Das","year":"2016","journal-title":"Journal of Adivasi and Indigenous Studies"},{"key":"2026082404152239000_16.8.e114655.16","doi-asserted-by":"crossref","first-page":"100256","DOI":"10.1016\/j.ssaho.2022.100256","article-title":"Burden of non-communicable diseases and its associated economic costs in India","volume":"5","author":"Menon","year":"2022","journal-title":"Social Sciences & Humanities Open"},{"key":"2026082404152239000_16.8.e114655.17","first-page":"557","article-title":"Study of prevalence and risk factors of non-communicable diseases among the adult population of Kokrajhar District, Assam","volume":"14","author":"Nath","year":"2024","journal-title":"Eur J Cardiovasc Med"},{"key":"2026082404152239000_16.8.e114655.18","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.18203\/2394-6040.ijcmph20251739","article-title":"A comparative study of National Family Health Survey-4 and National Family Health Survey-5 on nutritional indicators in Assam","volume":"12","author":"Saeed","year":"2025","journal-title":"Int J Community Med Public Health"},{"key":"2026082404152239000_16.8.e114655.19","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_347_20"},{"key":"2026082404152239000_16.8.e114655.20","unstructured":"Begum F . Socio-economic development of the tea tribes in Assam- an evaluation. Guwahati, Assam: Assam Institute of Research on Tribals and Scheduled Castes; 2017. Available: https:\/\/repository.tribal.gov.in\/bitstream\/123456789\/74131\/1\/AIRT_2017_0004_report.pdf [Accessed 5 Oct 2025]."},{"key":"2026082404152239000_16.8.e114655.21","unstructured":"Laskar HA , Laskar MA , Das PJ . Healthcare and socioeconomic dynamics of tea tribes in Cachar district, Assam. In: Lakshmanan R , Sohan Lal SGRI , Mary DA , et al ., eds. Modern trends in multidisciplinary research. Chhattisgarh, India: Authors Click Publishing, 2025: 32\u2013237."},{"key":"2026082404152239000_16.8.e114655.22","unstructured":"Bedamatta R . Morbidity status among tea garden workers of Assam: based on the survey of morbidity and mortality among tea garden workers in Dibrugarh, Jorhat, Sibsagar, and Tinsukia districts of Assam, 2021-22. Guwahati, Assam: Indian Institute of Technology Guwahati; 2025. 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