Epidemiology of appendicitis and appendectomy for the low-income population in Taiwan, 2003–2011

BMC Gastroenterology

Ren-Hao Pan⁴  Shun-Zhi Zhu³  Yuan-Hung Liu²  Robert K Lai⁴  Nan-Ping Yang¹  Chien-Lung Chan⁴  Kai-Biao Lin⁵ 

[1] Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;Section of Cardiology, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan;School of Computer & Information Engineering, Xiamen University of Technology, Xiamen 361024, China;Innovation Center for Big data and Digital Convergence, Yuan Ze University, Taoyuan 32003, Taiwan;Department of Computer Science and Engineering, Yuan Ze University, Taoyuan 32003, Taiwan

关键词: Socioeconomic status;    Low-income population;    Epidemiology;    Appendectomy;    Appendicitis;   

Others  :  1137280
DOI  :  10.1186/s12876-015-0242-1

 received in 2014-10-13, accepted in 2015-01-29,  发布年份 2015

【 摘 要 】

Background

Although numerous epidemiological studies on appendicitis have been conducted worldwide, only a few studies have paid attention to the effect of socioeconomic status on appendicitis, particularly studies focusing on the low-income population (LIP).

Methods

We analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database from 2003 to 2011. All cases diagnosed as appendicitis were enrolled.

Results

Between 2003 and 2011, 2,916 patients from the LIP and 209,206 patients from the normal population (NP) were diagnosed with appendicitis. Our finding revealed that the ratios of comorbidities, complicated appendicitis, and readmissions in LIP patients were slightly higher than those of NP patients. LIP patients were more likely to live in suburban and rural areas, and hence a higher proportion of them were hospitalized in a district or regional hospital compared with NP patients. The crucially finding was that the overall incidence ratios of appendicitis, acute appendicitis, and perforated appendicitis in the LIP were substantially higher than those in the NP (36.25%, 35.33%, and 37.28%, respectively). The mean LOS in LIP patients was longer than that of NP patients. The overall case-fatality ratio of appendectomy in the LIP was higher when compared with the NP (0.41% versus 0.12%, p < 0.05). We also observed that appendicitis was occurred frequently in male patients, with a higher incidence for those aged 15–29 years in both the LIP and NP. The incidences of incidental appendectomy showed a decreasing trend in both the LIP and NP. Finally, a valuable discovery was that the total hospital cost was comparable between the laparoscopic appendectomy (LA) and open appendectomy (OA) (1,178 ± 13 USD versus 1,191 ± 19 USD, p < 0.05) in LIP patients because they saved more hospitalization costs than NP patients when the previous one chose the LA.

Conclusion

This study confirmed that a lower socioeconomic status has significantly negative impact on the occurrence and treatment of appendicitis and appendectomy. In terms of hospital costs and LOS, LIP patients benefit more from the LA approach than they do from the OA approach in the treatment of appendicitis.

【 授权许可】

   
2015 Lin et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Chou YC, Lin SW: Report of the Survey of the Basic Needs for Low-income Families in Taoyuan County, Taiwan. Hsuan Chuang University, Taiwan; 2007.
• [2]Department of Statistics (DOS), Ministry of the Interior, Survey of Living Conditions of Low-income Households in Taiwan-Fuchien Area (2004). http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4700. Accessed 5 Feb 2015.
• [3]Department of Statistics (DOS), Ministry of the Interior, Survey of Living Conditions of Low-income Households in Taiwan-Fuchien Area (2001). http://sowf.moi.gov.tw/stat/Survey/90low-income.doc. Accessed 5 Feb 2015.
• [4]Department of Statistics (DOS), Ministry of the Interior, Survey of Living Conditions of Low-income Households in Taiwan-Fuchien Area (2008). http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4699. Accessed 5 Feb 2015.
• [5]Blomqvist HL P, Nyrén O, Ekbom A: Appendectomy in Sweden 1989–1993 assessed by the Inpatient Registry. J Clin Epidemiol 1998, 51(10):859-65.
• [6]Lee JH, Park YS, Choi JS: The Epidemiology of Appendicitis and Appendectomy in South Korea: National Registry Data. J Epidemiol 2010, 20(2):97-105.
• [7]Oguntola AS, Adeoti ML, Oyemolade TA: Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria. Ann Afr Med 2010, 9(4):213-7.
• [8]Rai R, D’Souza RC, Vijin V, Sudarshan SH, Aithala PS, Pai JR, et al.: An Evaluation of the Seasonal Variation in Acute Appendicitis. J Evol Med Dent Sci 2014, 3(2):257-60.
• [9]Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V: Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 2012, 175(2):185-90.
• [10]Addiss DG, Nathan S, Fowler BS, Tauxe RV: The Epidemiology of Appendicitis and Appendectomy in the United States. Am J Epidemiol 1990, 132(5):910-25.
• [11]Deng Y, Chang DC, Zhang Y, Webb J, Gabre-Kidan A, Abdullah F: Seasonal and day of the week variations of perforated appendicitis in US children. Pediatr Surg Int 2010, 26(7):691-6.
• [12]Paajanen H, Gronroos JM, Rautio T, Nordstrom P, Aarnio M, Rantanen T, et al.: A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial). BMC Surgery 2013, 13:3. BioMed Central Full Text
• [13]Ilves I, Fagerstrom A, Herzig KH, Juvonen P, Miettinen P, Paajanen H: Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland. World J Gastroenterol 2014, 20(14):4037-42.
• [14]Lee SL, Shekherdimian S, Chiu VY: Effect of race and socioeconomic status in the treatment of appendicitis in patients with equal health care access. Arch Surg 2011, 146(2):156-61.
• [15]Lee SL, Shekherdimian S, Chiu VY, Sydorak RM: Perforated appendicitis in children: equal access to care eliminates racial and socioeconomic disparities. J Pediatr Surg 2010, 45(6):1203-7.
• [16]Rogers SO Jr: Equal access to health care does not eliminate disparities in the management of adults with appendicitis. J Surg Res 2012, 173(1):49-50.
• [17]Nwomeh BC, Chisolm DJ, Caniano DA, Kelleher KJ: Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem? Pediatrics 2006, 117(3):870-5.
• [18]Huang T-H, Huang YC, Tu C-W: Acute appendicitis or not: Facts and suggestions to reduce valueless surgery. J Acute Med 2013, 3(4):142-7.
• [19]Wei PL, Chen CS, Keller JJ, Lin HC: Monthly variation in acute appendicitis incidence: a 10-year nationwide population-based study. J Surg Res 2012, 178(2):670-6.
• [20]Wei P-L, Liu S-P, Keller JJ, Lin H-C: Volume-Outcome Relation for Acute Appendicitis:Evidence from a Nationwide Population-Based Study. PloS One 2012, 7(12):1-5.
• [21]Huang N, Yip W, Chang HJ, Chou YJ: Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan. Public Health 2006, 120(11):1055-63.
• [22]Liu TL, Tsay JH, Chou YJ, Huang N: Comparison of the perforation rate for acute appendicitis between nationals and migrants in Taiwan, 1996–2001. Public Health 2010, 124(10):565-72.
• [23]Yeh CC, Wu SC, Liao CC, Su LT, Hsieh CH, Li TC: Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc 2011, 25(9):2932-42.
• [24]Yu CW, Juan LI, Wu MH, Shen CJ, Wu JY, Lee CC: Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis. Br J Surg 2013, 100(3):322-9.
• [25]Wang CC, Tu CC, Wang PC, Lin HC, Wei PL: Outcome comparison between laparoscopic and open appendectomy: evidence from a nationwide population-based study. PLoS One 2013, 8(7):e68662.
• [26]Taiwan NHI Information for the public: essential data of ensured affair. Accessed on Dec. 7, 2013. [Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=661&WD_ID=689&webdata_id=805]
• [27]Wen SWND: Diagnostic accuracy and short-term surgical outcomes in cases of suspected acute appendicitis. Can Med Assoc J 1995, 152:1617-26.
• [28]Andersson REHA, Thulin AJG: Diagnostic accuracy and perforation rate in appendicitis: Association with age and sex of the patient and with appendectomy rate. Eur J Surgery 1992, 158:37-41.
• [29]Walker ARPSI: What causes appendicitis? J Clin Gastroenterol 1990, 12:127-9.
• [30]Ministry of Health and Welfare, Taiwan Social Assistance Act. http://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=D0050078. Assessed 5 Feb 2015.
• [31]Department of Statistics (DOS), Ministry of Health and Welfare, The Survey Implementation Plan of Low-income and Moderate low-income Households Living Conditions in Taiwan-Fuchien Area (2013). http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4698. Accessed 5 Feb 2015.
• [32]Davis RLP: The Epidemiology of Acute Appendicitis in California: Racial, Gender, and Seasonal Variation. Epidemiology 1991, 2(5):323-30.
• [33]Mohammed Al-Omran MMM, Robin ML: Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg 2003, 46(4):263-8.
• [34]Sanda RB. Epidemiologic Features of Appendicitis, Appendicitis. In: A Collection of Essays from Around the World. edn. Edited by (Ed.) DAL. ISBN: 978-953-307-814-4, InTech, Available from: http://www.intechopen.com/books/appendicitis-a-collection-of-essays-from-around-the-world/epidemiologicfeatures-of-appendicitis; 2012.
• [35]Short AR: The causation of appendicitis. Br J Surg 1920, 8(30):171-88.
• [36]Liggins DJBaA: Acute appendicitis in nine British towns Br Med J (Clin Res Ed) 1981, 283(6299):1083-5.
• [37]Alder AC, Fomby TB, Woodward WA, Haley RW, Sarosi G, Livingston EH: Association of viral infection and appendicitis. Arch Surg 2010, 145(1):63-71.
• [38]Thalayasingam B: Acute appendicitis and infectious mononucleosis. BMJ 1985, 13(291):140-1.
• [39]Livingston EH, Woodward WA, Sarosi GA, Haley RW: Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg 2007, 245(6):886-92.
• [40]Livingston EH, Fomby TB, Woodward WA, Haley RW: Epidemiological similarities between appendicitis and diverticulitis suggesting a common underlying pathogenesis. Arch Surg 2011, 146(3):308-14.
• [41]Sulu B. Demographic and Epidemiologic Features of Acute Appendicitis. In: Appendicitis-A Collection of Essays from Around the World. edn. Edited by (Ed.) DAL. ISBN: 978-953-307-814-4, InTech, Available from: http://www.intechopen.com/books/appendicitis-a-collection-of-essays-from-around-theworld/demographic-and-epidemiologic-features-of-acute-appendicitis; 2012.
• [42]Andersen SB, Paerregaard A, Larsen K: Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996–2004. Eur J Pediatr Surg 2009, 19(5):286-9.
• [43]Koepsell TDIT, Farewell VT: Factors affecting perforation in acute appendicitis. Surg Gynecol Obstet 1981, 153:508-10.
• [44]Scher KSCJ: Appendicitis: factors that influence the frequency of perforation. South Med J 1980, 73:1561-3.
• [45]Noudeh YJ, Sadigh N, Ahmadnia AY: Epidemiologic features, seasonal variations and false positive rate of acute appendicitis in Shahr-e-Rey, Tehran. Int J Surg 2007, 5(2):95-8.
• [46]Kaplan GG, Dixon E, Panaccione R, Fong A, Chen L, Szyszkowicz M, et al.: Effect of ambient air pollution on the incidence of appendicitis. Can Med Assoc J 2009, 181(9):591-7.
• [47]Yang NP, Chan CL, Yu IL, Lee CY, Chou P: Estimated prevalence of orthopaedic fractures in Taiwan–A cross-sectional study based on nationwide insurance data. Injury 2010, 41(12):1266-72.
• [48]Yang NP, Chen HC, Phan DV, Yu IL, Lee YH, Chan CL, et al.: Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000–2005. BMC Muscoskel Disord 2011, 12:253. BioMed Central Full Text