Oral cancer screening in India: a secondary analysis of disparities using national family health survey data.
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BACKGROUND: This study examines the differences in oral cancer screening across Indian states by comparing regions with high and low tobacco prevalence and aimed to identify and quantify the factors associated with intergroup differences in oral cancer screening. METHODS: National Family Health Survey (NFHS-5) data from 2019 to 21 were used to examine screening participation among 1,484,249 participants aged 15-49 years. Descriptive statistics, chi-square tests, and binary logistic regression models were used to evaluate the factors affecting screening participation. A Fairlie decomposition analysis was also performed. RESULTS: The national average for oral cancer screening in India was only 4.4 per 1,000 people, indicating low participation and highlighting serious shortcomings in the national screening programme. Screening participation is directly related to lower tobacco prevalence in the population. The study found that people from high-tobacco-prevalence states were 42 % less likely to be screened (Adjusted Odds Ratio (AOR): 0.58, p < 0.01) than those from low-prevalence states. Screening rates were higher among females, older respondents, wealthier groups, and married individuals. Conversely, rates were lower for Scheduled Tribes, rural residents, and less educated participants. The decomposition results showed that wealth (110.61 %), age (28.62 %), and marital status (24.85 %) increased the disparities in oral cancer screening, but education (-59.78 %) and sex (-34.70 %) decreased the gap between groups. CONCLUSIONS: The analysis reveals substantial gaps in India's oral cancer screening programme, with extremely low participation rates, suggesting that the programme has failed to achieve its intended coverage.