Abstract
Appendicitis is a common surgical condition for children. However, environmental effects, such as piped water supply, on pediatric appendicitis risk remain unclear. This longitudinal, nationwide, cohort study aimed to compare the risk of appendicitis among children with different levels of piped water supply. Using data from Taiwan Water Resource Agency and National Health Insurance Research Database, we identified 119,128 children born in 1996–2010 from areas of the lowest piped water supply (prevalence 51.21% to 63.06%) as the study cohort; additional 119,128 children of the same period in areas of the highest piped water supply (prevalence 98.97% to 99.63%) were selected as the controls. Both cohorts were propensity-score matched by baseline variables. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of appendicitis in the study cohort compared to the controls by Cox proportional hazards regression. The study cohort had a raised overall incidence rates of appendicitis compared to the control cohort (12.8 vs. 8.7 per 10,000 person-years). After covariate adjustment, the risk of appendicitis was significantly increased in the study cohort (adjusted HR = 1.46, 95% CI: 1.35, 1.58, p < 0.001). Subgroup and sensitivity analyses showed consistent results that children with low piped water supply had a higher risk of appendicitis than those with high piped water supply. This study demonstrated that children with low piped water supply were at an increased risk of appendicitis. Enhancement of piped water availability in areas lacking adequate, secure, and sanitized water supply may protect children against appendicitis.
Highlights
Appendicitis is the most common surgical condition for children, with an annual incidence of approximately 0.1% and cumulative incidence of 3.2% by age 20 [1,2]
This study demonstrated that children with low piped water supply were at an increased risk of appendicitis
The overall incidence rate of appendicitis was increased in the study cohort compared to the control cohort (12.8 vs. 8.7 per 10,000 person-years), reflecting an absolute excess risk of 4.1 cases per
Summary
The design and reporting of this study followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines [16] (Supplementary STROBE-checklist).2.1. This retrospective cohort study uses Taiwan National Health Insurance (TNHI) database to assess the health outcomes of participants, and statistical data from Taiwan Water Resources. Agency (TWRA) for the exposure of piped water supply. Both datasets were linked by the residential areas of participants. The TNHI database contains comprehensive medical claims data (clinic visit date, admission date, prescription, and operation records), disease status (diseases diagnosis), and demographics (sex, birthday, income, residential area) of each enrollee. This study was approved by the Research Ethics Committee of China Medical University and Hospital in Taiwan (CMUH-104REC2-115 and CRREC-103-048) for exemption of informed consents
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