Problem considered Tobacco pouch keratosis (TPK), an oral potentially malignant disorder (OPMD), remains poorly studied in India, with fragmented and geographically heterogeneous evidence. We estimated the community-based pooled prevalence (CBPP) of TPK and examined variation by region and population characteristics. Methods This review was registered in PROSPERO and conducted in accordance with the PRISMA guidelines. PubMed, EMBASE, and Scopus were searched for community-based studies published since 2000, supplemented by citation tracking. A random-effects meta-analysis (logit transformation) was performed to estimate the CBPP of TPK with 95% confidence intervals (CIs). Prediction intervals, subgroup analyses, publication bias, and sensitivity analysis were assessed. Results Thirteen studies comprising 16,169 participants and 668 TPK cases were included. The CBPP of TPK cross the included studies was 3.0% (95% CI: 1.0-8.0), with substantial heterogeneity (I 2 = 99.2%). Prevalence was higher in the Eastern region (23.0%; 95% CI: 17.0%–29.0%) followed by the Northern region (9.0%; 95% CI: 6.0%–13.0%). Tribal population had a higher prevalence (9.0%; 95% CI: 2.0%–28.0%) than occupational groups (5.0%; 95% CI: 1.0%–28.0%). Leave-one-out analysis supported the stability of the pooled estimate, while Egger's test suggested small-study effects ( p = 0.0009). Conclusion The pooled estimate reflects heterogeneous community-based evidence rather than a precise national prevalence, with variation across geographical regions and population groups. Targeted tobacco-control and prevention strategies, alongside longitudinal community-based studies, are needed to better characterize TPK prevalence and its malignant transformation potential.
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Sivamani et al. (2026) studied this question.
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