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Meta-Analysis
. 2024 Nov 6:12:e18385.
doi: 10.7717/peerj.18385. eCollection 2024.

Prevalence of oral submucous fibrosis across diverse populations: a systematic review and meta-analysis

Mengqi Wang #  1 , Chengchen Duan #  1 , Yuzi Wei  1 , Xiaoping Xu  1
Affiliations
Meta-Analysis

Prevalence of oral submucous fibrosis across diverse populations: a systematic review and meta-analysis

Mengqi Wang et al. PeerJ. .

Abstract

Purpose: The aim is to offer a comprehensive overview of oral submucous fibrosis (OSF) prevalence and explore its epidemiological characteristics across various demographic groups and geographical locations, thereby helping the formulation of public health management policies.

Methods: Studies reporting OSF prevalence were identified from electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, EMBASE via OVID, and Web of Science. Pooled prevalence and quality assessment using the New-Ottawa Scale were conducted. Two reviewers screened and selected records, assessed quality, and independently extracted data. This systematic review and meta-analysis followed the PRISMA guidelines and was registered on PROSPERO (CRD42024532975).

Results: Sixty-three studies, encompassing 11,434 cases in a total population of 769,860, reported OSF prevalence. The majority of studies (forty-one) were from India. The pooled prevalence of OSF across all populations was 3.0% (95% CI [2.8-3.2]%). In non-risk populations, risk populations, and consecutive dental patients, the pooled prevalence stood at 2.4% (95% CI [2.1-2.6]%), 4.5% (95% CI 3.5-5.6%), and 5.6% (95% CI [3.8-7.5]%), respectively. Subgroup analysis by age, sex, and geographical region revealed higher prevalence rates among those aged 50 and above (4.2%, 95% CI [3.0-5.4]%), males (3.3%, 95% CI [2.9-3.7]%), and in India (4.0%, 95% CI [3.7-4.3]%). As the exposure to risk factors exceeded 50% in the surveyed population, the prevalence of OSF notably increased. Most studies met satisfactory quality standards.

Conclusions: Our research findings reveal a comprehensive prevalence of OSF across all populations at 3.0% (95% CI [2.8-3.2]%). And, existing evidence indicates a relatively low prevalence of OSF associated with tobacco, alcohol, and Areca (betel) nut use. However, further large-scale studies are recommended to validate these findings. Understanding the prevalence and distribution patterns of OSF may assist in healthcare intervention planning and alleviate the oral cancer burden associated with OSF.

Keywords: Evidence-based dentistry; Global prevalence; Oral submucous fibrosis.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources.
Figure 2
Figure 2. Forest plot of prevalence of OSF among different population.
This is a forest plot illustrating the prevalence of OSF in different populations and the overall prevalence. It categorizes the surveyed groups based on the literature included, with the following order from top to bottom: non-risk population, consecutive dental patients, and risk population. The chart lists the original data and the calculated prevalence rates from each study, and then summarizes the OSF prevalence in these groups. As depicted in the chart, the prevalence of OSF in the non-risk population is 2.4% (95% CI = 2.1−2.6%); in consecutive dental patients, it is 5.6% (95% CI = 3.8−7.5%); and in the risk population, it is 4.5% (95% CI = 3.5−5.6%). The overall prevalence of OSF across all populations is 3.0% (95% CI = 2.8−3.2%).
Figure 3
Figure 3. Subgroup analysis of the prevalence of OSF based on gender, age, and country.
This is a forest plot for the subgroup analysis of OSF prevalence by gender, country, and age. By collecting data on the gender, country, and age of patients from the included literature, it is observed that in the gender subgroup analysis, males have a higher prevalence of OSF at 3.3%, while females have a prevalence of 1.0%. In the country subgroup analysis, India has the highest OSF prevalence at 4.0%, followed by Indonesia at 3%, China at 2.1%, Sri Lanka at 1.6%, and the United States shows the lowest prevalence at 0.3%. In the age subgroup analysis, individuals over 50 years old exhibit the highest OSF prevalence at 4.2%, whereas the prevalence is relatively lower, around 3.2%, in individuals under 40 years old and those aged 40–50 years.
Figure 4
Figure 4. Subgroup analysis of the prevalence of OSF based on tobacco use, alcohol use, and betel nut consumption among the populations included.
Subgroup analysis of OSF prevalence under different types and degrees of risk factors: When the percentage of alcohol use, areca (betel) nut use, and tobacco use in the surveyed population exceeds 50%, the prevalence of OSF significantly increases, to 5.8% (95% CI = 0.7–10.9%), 5.6% (95% CI = 4.1−7.1%), and 7.2% (95% CI = 4.8−9.6%), respectively. Moreover, only tobacco use shows a phenomenon where the incidence of OSF rises with the increase in the percentage of tobacco use in the surveyed population. Meta-regression analysis further suggests that tobacco use predominantly explains the heterogeneity source (see Supplementary Materials 3–5).
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Grants and funding

This research was supported by the Research Funding from West China School/Hospital of Stomatology Sichuan University (No. RCDWJS2022-17 and RD-02-202205), the CAMS Innovation Fund for Medical Sciences (CIFMS, 2019-I2M-5-004), the National Natural Science Foundation of China (No. 82273165), the Sichuan Science and Technology Program (No. 2022NSFSC1495), and Major Project of Natural Science Foundation of Hunan Province (open competition, 2021JC0002). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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