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Aim <p>To evaluate the risk of oral premalignant lesions (OPMLs) among smokeless tobacco (SLT) users in unorganised Indian workers using survival analysis, while accounting for uncertainty in exposure and event timing.</p> Subject and methods <p>A retrospective analytical study was conducted using a synthetic cohort of 800 unorganised workers aged 18–65&#xa0;years. Time-to-event data for OPMLs were analysed using Kaplan–Meier survival curves, log-rank tests, and Cox proportional hazards models. A fuzzy Cox regression approach incorporating α-cut levels (0.25, 0.50, 0.75) was applied to address imprecision in exposure duration and lesion onset. Hazard ratios (HRs) with 95% confidence intervals (CIs) and model performance metrics were estimated.</p> Results <p>SLT users exhibited significantly lower lesion-free survival than non-users (log-rank <i>p</i> &lt; 0.001). In the classical Cox model, SLT use was associated with a greater than twofold increased risk of OPMLs (HR = 2.35; 95% CI 1.82–3.05). The fuzzy Cox model produced comparable but more robust estimates, with a defuzzified hazard ratio of 2.37 and improved predictive performance (concordance index = 0.78 vs 0.72). Survival probabilities declined progressively with increasing exposure duration.</p> Conclusion <p>Smokeless tobacco use substantially increases the risk of oral premalignant lesions among unorganised workers. Incorporating fuzzy survival modelling provides a reliable framework for handling uncertainty in epidemiological data. Targeted screening and tobacco cessation interventions are urgently needed in vulnerable occupational populations.</p>

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Risk of oral premalignant lesions among smokeless tobacco users in unorganised Indian workers: a fuzzy survival analysis approach

  • 期刊论文

  • 发表日期：

    2026年5月21日

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  • M. Sundar,
  • M. Siva

摘要

Aim

To evaluate the risk of oral premalignant lesions (OPMLs) among smokeless tobacco (SLT) users in unorganised Indian workers using survival analysis, while accounting for uncertainty in exposure and event timing.

Subject and methods

A retrospective analytical study was conducted using a synthetic cohort of 800 unorganised workers aged 18–65 years. Time-to-event data for OPMLs were analysed using Kaplan–Meier survival curves, log-rank tests, and Cox proportional hazards models. A fuzzy Cox regression approach incorporating α-cut levels (0.25, 0.50, 0.75) was applied to address imprecision in exposure duration and lesion onset. Hazard ratios (HRs) with 95% confidence intervals (CIs) and model performance metrics were estimated.

Results

SLT users exhibited significantly lower lesion-free survival than non-users (log-rank p < 0.001). In the classical Cox model, SLT use was associated with a greater than twofold increased risk of OPMLs (HR = 2.35; 95% CI 1.82–3.05). The fuzzy Cox model produced comparable but more robust estimates, with a defuzzified hazard ratio of 2.37 and improved predictive performance (concordance index = 0.78 vs 0.72). Survival probabilities declined progressively with increasing exposure duration.

Conclusion

Smokeless tobacco use substantially increases the risk of oral premalignant lesions among unorganised workers. Incorporating fuzzy survival modelling provides a reliable framework for handling uncertainty in epidemiological data. Targeted screening and tobacco cessation interventions are urgently needed in vulnerable occupational populations.