Disparities in oral cancer screening among Indian women aged 30-49: insights from a national survey.

Introduction: Oral cancer estimates are concerning in India, with inequalities in accessing screening services, especially in rural areas. Socioeconomic characteristics contribute to disparities in screening coverage. The current study estimates the coverage of self-reported screening, spatial patterns, differences in screening rates in urban and rural areas and determinants of screening among Indian women. Methodology: We analysed data from 348,882 women (30-49 years) participating in India's fifth wave of the National Family Health Survey (NFHS-5). Self-reported oral cancer screening weighted coverage was estimated and compared per socio-demographic characteristics. Global and local spatial autocorrelation methods were applied to understand the spatial distribution of screening coverage, which was then depicted using choropleth maps. The differences in urban-rural screening were decomposed and determinants of screening were identified using the multivariable binary logistic regression. Analysis was done using Stata v17.0. Results: Overall, at the national level, self-reported screening coverage was 0.87%, with higher rates in urban areas (1.08%) compared to rural areas (0.77%). Screening uptake increased with age, socioeconomic status and education. Scheduled Tribes and the poorest quintile had the lowest rates. 348,882 participants were included in the final analysis after all exclusions. The uptake of oral cancer screening increased with an increase in wealth Index (Middle: adjusted odds ratio: 1.35; 95% CI: 1.07-1.70), Richer (1.43; 1.12-1.84), Richest (1.60; 1.20-2.13) and in obese women (1.28; 1.02-1.63). Meanwhile, women who belonged to the Muslim religion (0.68; 95% CI: 0.56-0.84), scheduled tribes (0.70; 95% CI: 0.53-0.84) and those who were illiterate (0.66; 0.51-0.85) had lower odds of screening uptake. Women from South Indian states (9.58; 95% CI: 7.60-12.07), West Indian states (3.81; 95% CI: 2.88-5.04), Central India (2.48; 95% CI: 1.95-3.14) and North-east Indian states (1.65; 95% CI: 1.20-2.27) had higher odds of oral cancer screening uptake compared to North Indian states. The urban-rural gap was 57.76% due to factor distribution and 42.24% due to differences in factor effects. Religion, caste, education and media exposure all significantly contributed to the gap. Conclusion: Screening uptake varied according to socio-economic status and region of the country. Significant disparities in oral cancer screening exist among urban and rural women, driven by socioeconomic factors. Enhancing healthcare access, education and media outreach in rural areas is essential to improving screening rates and reducing disparities.