Sociodemographic and Environmental Factor of Tuberculosis: Retrospective Study in Penampang, Sabah Introduction Tuberculosis (TB) remains a critical global and national public health concern, with Penampang, Sabah experiencing a continuous burden and increasing case trends. Existing literature lacks localized research on the connection between environmental factors, particularly air quality, and TB incidence in specific district-level contexts like Penampang. Methods This retrospective cross-sectional study aimed to investigate the association of sociodemographic factors and Air Pollution Index (API) with TB cases in Penampang from 2019-2023, utilizing data from the National Tuberculosis Registry and Department of Environment. Results Results indicated a statistically significant association between age and TB cases (p<0.001), while no significant association was found for gender or nationality. While Moran’sI measures global spatial clustering, LISA identifies local clusters of TB cases, spatial analysis identified Donggongon as a localized TB hotspot, alongside an overall dispersed distribution across Penampang (Moran's I = -0.143, p<0.001). Furthermore, statistically, API showed no overall significant correlation with TB cases (p=0.070) and also no global spatial autocorrelation was observed between TB cases and the API in Penampang (Moran's I = 0); however, LISA analysis identified specific local clusters (p=0.01) where a significant spatial correlation between TB incidence and API levels was present allowing the study to distinguish between overall and localized spatial patterns. Conclusions The study shows that Sociodemographic, environmental, and spatial factors are all linked in the spread of TB. Effective public health measures must be tailored to these specific contexts. Future research should collect more detailed environmental and individual-level data to create better-targeted interventions.