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World Journal of Emergency Surgery

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Open Access 01-12-2015 | Research article

Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study

Authors: Kai-Biao Lin, K. Robert Lai, Nan-Ping Yang, Chien-Lung Chan, Yuan-Hung Liu, Ren-Hao Pan, Chien-Hsun Huang

Published in: World Journal of Emergency Surgery | Issue 1/2015

Abstract

Introduction

This paper presents an epidemiologic study of appendicitis in Taiwan over a twelve-year period. An analysis of the incidence in the low-income population (LIP) is included to explore the effects of lower socioeconomic status on appendicitis.

Methods

We analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database (NHIRD) from 2000 to 2011. All cases diagnosed as appendicitis were enrolled.

Results

The overall incidences of appendicitis, primary appendectomy, and perforated appendicitis were 107.76, 101.58, and 27.20 per 100,000 per year, respectively. The highest incidence of appendicitis was found in persons aged 15 to 29 years; males had higher rates of appendicitis than females at all ages except for 70 years and older. Appendicitis rates were 11.76 % higher in the summer than in the winter months. A multilevel analysis with hierarchical linear modeling (HLM) revealed that male patients, younger patients (aged ≤14 years), and elderly patients (aged ≥60 years) had a higher risk of perforated appendicitis; among adults, the incidence increased with age. Moreover, the risk of perforation was higher in patients with one or more comorbidities. LIP patients comprised 1.25 % of the total number of patients with appendicitis from 2000 to 2011. The overall incidence of appendicitis was 34.99 % higher in the LIP than in the normal population (NP), and the incidence of perforated appendicitis was 40.40 % higher in the LIP than in the NP. After multivariate adjustment, the adjusted hospital costs and length of hospital stay (LOS) for the LIP patients were higher than those for the NP patients.

Conclusions

Appendicitis and appendectomy in Taiwan had similar overall incidences, seasonality patterns, and declining trends compared to numerous previous studies. Compared to NP patients, LIP patients had a higher risk of appendicitis, longer LOS and higher hospital costs as a result of appendectomy.

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.CrossRef

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 Surg. 2013;13:3. doi:10.1186/1471-2482-13-3.PubMedCentralCrossRefPubMed

David G, Addiss NS, Barbara S, Fowler BS, Tauxe RV. The Epidemiology of Appendicitis and Appendectomy in the United States. Am J Epidemiol. 1990;132(5):910–25.

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. doi:10.3748/wjg.v20.i14.4037.PubMedCentralCrossRefPubMed

Aarabi S, Sidhwa F, Riehle KJ, Chen Q, Mooney DP. Pediatric appendicitis in New England: epidemiology and outcomes. J Pediatr Surg. 2011;46(6):1106–14. doi:10.1016/j.jpedsurg.2011.03.039.CrossRefPubMed

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. doi:10.1016/j.jss.2011.07.017.CrossRefPubMed

Rai R, D’Souza RC, V V, Sudarshan SH, P.S A, Pai. J R, et al. An Evaluation of the Seasonal Variation in Acute Appendicitis. J Evol Med Dental Sci. 2014;3(2):257–60. doi:10.14260/jemds/2014/1818.

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. doi:10.2188/jea.JE20090011.PubMedCentralCrossRefPubMed

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. doi:10.1016/j.jacme.2013.10.003.CrossRef

10.

Chao PW, Ou SM, Chen YT, Lee YJ, Wang FM, Liu CJ, et al. Acute appendicitis in patients with end-stage renal disease. J Gastrointesti Surg. 2012;16(10):1940–6. doi:10.1007/s11605-012-1961-z.CrossRef

11.

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. doi:10.1016/j.jss.2012.06.034.CrossRefPubMed

12.

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. doi:10.1371/journal.pone.0068662.PubMedCentralCrossRefPubMed

13.

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. doi:10.1371/journal.pone.0052539.t001.

14.

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. doi:10.1002/bjs.9008.CrossRefPubMed

15.

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. doi:10.1016/j.puhe.2006.06.011.CrossRefPubMed

16.

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. doi:10.1016/j.puhe.2010.05.009.CrossRefPubMed

17.

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. doi:10.1007/s00464-011-1645-x.CrossRefPubMed

18.

Lin K-B, Chan C-L, Yang N-P, Lai RK, Liu Y-H, Zhu S-Z et al. Epidemiology of appendicitis and appendectomy for the low-income population in Taiwan, 2003–2011. BMC Gastroenterology. 2015;15(1). doi:10.1186/s12876-015-0242-1.

19.

Taiwan NHI Information for the public: essential data of ensured affair. [Available at : http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=661&WD_ID=689&webdata_id=805]. Assessed 5 Feb 2015.

20.

Ministry of Health and Welfare, Taiwan Social Assistance Act. http://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=D0050078. Assessed 5 Feb 2015.

21.

Diez-Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21:171–92. doi:10.1146/annurev.publhealth.21.1.171.CrossRefPubMed

22.

Mohammed Al-Omran MMM, Robin ML. Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg. 2003;46(4):263–8.PubMedCentralPubMed

23.

Roger Luckmann PD. The Epidemiology of Acute Appendicitis in California: Racial, Gender, and Seasonal Variation. Epidemiology. 1991;2(5):323–30.CrossRef

24.

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. doi:10.1016/j.ijsu.2006.03.009.CrossRefPubMed

25.

OSR MD. Appendicitis-a study of incidence, death rates and consumption of hospital resources. Postgrad Med J. 1984;60:341–5.CrossRef

26.

Barker D. Acute appendicitis and dietary fibre: an alternative hypothesis. Br Med J. 1985;290:1125–7.CrossRef

27.

Raguveer-Saran MKKN. The falling incidence of appendicitis. Br J Surg. 1980;67(9):681.CrossRefPubMed

28.

Arnbjornsson EAN-G, Westin SI. Decreasing incidence of acute appendicitis with special reference to the consumption of dietary fiber. Acta Chir Scand. 1982;148:461–4.PubMed

29.

Noer T. Decreasing incidence of acute appendicitis. Acta Chir Scand. 1975;141:431–2.PubMed

30.

Palumbo L. Appendicitis: Is it on the wane? Am J Surg. 1969;98:702–3.CrossRef

31.

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. doi:10.4103/1596-3519.70956.CrossRefPubMed

32.

Susan M, Bernard JMS, Anne G, Ebi KL, Isabelle R. The Potential Impacts of Climate Variability and Change on Air Pollution-Related Health Effects in the United States. Environ Health Perspect. 2001;109(2):199–209.CrossRef

33.

Nguyen NT, Zainabadi K, Mavandadi S, Paya M, Stevens CM, Root J, et al. Trends in utilization and outcomes of laparoscopic versus open appendectomy. AmJ Surg. 2004;188(6):813–20. doi:10.1016/j.amjsurg.2004.08.047.CrossRef

34.

Koepsell TDIT, Farewell VT. Factors affecting perforation in acute appendicitis. Surg Gynecol Obstet. 1981;153:508–10.PubMed

35.

Scher KSCJ. Appendicitis: factors that influence the frequency of perforation. South Med J. 1980;73:1561–3.CrossRefPubMed

36.

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. doi:10.1503/cmaj.082068.CrossRef

37.

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. doi:10.1007/s00383-010-2628-z.CrossRefPubMed

38.

Yang NP, Deng CY, Chou YJ, Chen PQ, Lin CH, Chou P, et al. Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy. 2006;75(3):329–37. doi:10.1016/j.healthpol.2005.04.009.CrossRefPubMed

39.

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 Musculoskelet Disord. 2011;12:253. doi:10.1186/1471-2474-12-253.PubMedCentralCrossRefPubMed

40.

Yang NP, Chan CL, Chu D, Lin YZ, Lin KB, Yu CS, et al. Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan: 2000–2011 National Health Insurance data surveillance. BioMed Res Intl. 2014;2014:878601. doi:10.1155/2014/878601.

41.

Cheng HT, Wang YC, Lo HC, Su LT, Soh KS, Tzeng CW et al. Laparoscopic appendectomy versus open appendectomy in pregnancy: a population-based analysis of maternal outcome. Surgical endoscopy. 2014. doi:10.1007/s00464-014-3810-5.

Title: Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study
Authors: Kai-Biao Lin
K. Robert Lai
Nan-Ping Yang
Chien-Lung Chan
Yuan-Hung Liu
Ren-Hao Pan
Chien-Hsun Huang
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2015
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-015-0036-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Epidemiology and socioeconomic features of appendicitis in Taiwan: a 12-year population-based study

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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