Prevalence and Risk-Factor Profile of Oral Premalignant Lesions Among Tobacco Users Attending a Tertiary-Care Centre in South India: A Hospital-Based Cross-Sectional Study

Abstract

Background. Oral potentially malignant disorders (OPMDs) precede a substantial proportion of oral squamous cell carcinomas, and South India carries a disproportionate burden owing to widespread tobacco and areca-nut use. Objective. To estimate the prevalence of oral premalignant lesions and describe their risk-factor profile among tobacco users attending a tertiary-care centre. Methods. In this hospital-based cross-sectional study, 300 adult current or former tobacco users underwent a structured interview and standardized oral examination. The primary outcome was the presence of a clinically suspected oral premalignant lesion. Prevalence was estimated with 95% confidence intervals (CI); associations with candidate risk factors were assessed using chi-square tests and odds ratios (ORs), with p<0.05 considered significant. Results. Participants were predominantly male (234/300, 78%), with a mean age of 47.1 (SD 17.7) years and mean tobacco-use duration of 12.7 (SD 7.6) years. Ninety-five participants had an oral premalignant lesion, an overall prevalence of 31.7% (95% CI 26.4-36.9%). Oral sub mucous fibrosis (35.8%) and leukoplakia (32.6%) were the commonest lesion types. Prevalence was higher among dual (36.8%) and smokeless-only (36.1%) tobacco users than smokers (22.9%). Regular alcohol use (OR 2.15, 95% CI 1.20-3.85; p<0.01) and areca-nut use (OR 1.74, 95% CI 1.04-2.91; p<0.05) were significantly associated with lesions; dual tobacco use, prolonged duration, poor oral hygiene, dental trauma and older age showed positive but non-significant associations. Conclusion. Nearly one in three tobacco users attending this centre had an oral premalignant lesion, with areca-nut and regular alcohol use as key modifiable correlates. The findings reinforce the need for opportunistic oral examination, areca-nut and alcohol counselling, and integrated tobacco-cessation services in high-burden South Indian settings.