Tea-tribe communities in Assam face a high stroke burden (prevalence 4.3%), substantial disability, and major gaps in timely diagnosis and care, with hypertension—especially combined with salt-added tea—being the strongest risk factor.
The prevalence of physician-diagnosed stroke among tea-tribe adults in Cachar district was 4.3%.
Stroke prevalence was higher among older adults, men, unemployed or semiskilled/skilled workers, and households below the poverty line.
Hypertension was the strongest risk factor for stroke, and its combination with daily consumption of salt-added tea was associated with markedly higher odds of stroke.
Fewer than half of stroke survivors reached a health facility within 4.5 hours or underwent CT or MRI imaging.
Stroke survivors in the tea-tribe community had high functional and psychological burdens.
A logistic regression-based classification score (0–19 points) showed good discrimination and calibration for identifying prevalent stroke.
Tea-tribe communities in Assam face socioeconomic marginalisation, limited access to formal healthcare, and distinct cultural practices that shape the stroke burden.
This research suggests that tea-tribe workers in the Cachar district of Assam, Northeast India, have a strikingly high rate of stroke—about 4.3% of adults surveyed had a history of stroke, which is substantially elevated compared to many general populations. The study surveyed nearly 3,800 people living on tea estates through door-to-door visits, with stroke cases confirmed by a specialist neurologist via teleconsultation. People who were older, male, poor, or had high blood pressure were most likely to have had a stroke. A particularly notable finding was that combining high blood pressure with the cultural practice of drinking tea with added salt was linked to much higher odds of stroke. The study also found serious gaps in emergency care: fewer than half of stroke survivors managed to reach a hospital within 4.5 hours of their stroke—the critical window for receiving clot-dissolving treatment—and fewer than half received a brain scan (CT or MRI). Those who survived strokes were living with significant physical disabilities and psychological problems. These findings highlight how geographic isolation, poverty, and limited healthcare infrastructure leave a vulnerable community without adequate stroke prevention and treatment. To help address this, the researchers developed a simple point-based scoring tool (0–19 points) using information about a person's age, socioeconomic status, and vascular risk factors that could help community health workers identify who is at highest risk of stroke. People scoring above 13 had a stroke prevalence of 14.5%, more than three times the overall rate. The researchers caution that this tool needs testing in other populations before widespread use, and that the cross-sectional design of the study limits conclusions about cause and effect.
Nambiar V, Verma V, Nunia S, Jubair M, Rani K, Jaiswal S, et al.. (2026). 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.. BMJ open. https://doi.org/10.1136/bmjopen-2025-114655