Decomposing Oral Cancer Screening Inequalities Across Wealth Index among Indian Women Aged 30-49 Years: Findings From National Family Health Survey-5.

Background: Early detection of oral cancer is critical for reducing morbidity and mortality, yet uptake of screening among women remains low. Socio-economic disparities in screening can hinder equitable health outcomes. This study aimed to quantify inequalities in oral cancer screening among women and identify key contributors using decomposition analysis. Methods: We analyzed nationally representative survey data of women aged 30-49 years. Self-reported oral cancer screening was the outcome of interest. Socio-economic inequality was measured using the concentration index, and decomposition analysis was performed to assess the relative contribution of demographic, socio-economic, behavioral, and healthcare access factors. Results: Screening uptake was low and disproportionately concentrated among socio-economically advantaged women (Concentration Index: 0.006, 95% Confidence Interval: 0.005-0.007). Decomposition analysis revealed that education, household wealth, place of residence, and access to health information were the main contributors to observed inequalities, whereas age and marital status had smaller effects. Conclusion: Significant socio-economic inequalities exist in oral cancer screening among women. Policies should focus on equity-oriented strategies, including targeted outreach to disadvantaged groups, integration of screening into primary and women-centric healthcare services, and strengthened health education. Reducing these disparities is essential for improving early detection and ensuring equitable oral cancer prevention.