Oral Potentially Malignant Disorders in Thailand: Regional Variations and Ecological Determinants

OBJECTIVES: To quantify the provincial heterogeneity incidence of oral potentially malignant disorders (OPMDs) and explore geographic disparities and ecological determinants in Thailand through Bayesian disease mapping. METHODS: An observational ecological study analyzed clinically diagnosed OPMDs from Thailand's national electronic health record database (2023 to 2024) except Bangkok. Spatial autocorrelation with spatial Bayesian hierarchical models were used to evaluate their associations with behavioral, socioeconomic, and oral-health determinants. RESULTS: A total of 5,956 OPMDs diagnoses were identified across 76 provinces. The median age at diagnosis was 62 y, with females comprising 68.2%. Lichen planus (45.9%) and leukoplakia (39.5%) were the predominant subtypes. The age-standardized incidence rate was 1.9 per 100,000 (female: 2.5; male: 1.3), peaking at ages 60 to 69 y. Spatial analyses revealed high-risk clusters in northern Thailand and identified smokeless tobacco use, dentist density, and Gini coefficient as significant ecological predictors of the incidence of OPMDs. CONCLUSIONS: This population-based analysis demonstrates spatial disparities in the incidence of OPMDs. Contextual social determinants of health including socioeconomic inequality, smokeless tobacco behaviors, and workforce availability contribute to variations in disease distribution at the population level. Strengthening the integration of big data analytics within oral health surveillance systems can enhance timely, evidence-informed decision-making and support the strategic refinement and resource optimization of Thailand's national oral cancer screening benefit package.Knowledge Transfer Statement:The results provide strategic insights for clinicians, public health professionals, and policymakers identifying high-risk geographic areas where preventive interventions and early detection efforts should be prioritized. By clarifying province-specific risk profiles, the study supports the development of targeted health promotion, prevention, and screening strategies aimed at reducing geographic inequalities and improving oral health outcomes.