Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study

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.

A review of the function and evolution of the cecal appendix

“…However, as these factors vary by socioeconomic class, which invariably impacts diet, the role of dietary differences between samples cannot be excluded. Additionally, subsequent studies have directly refuted the correlation between good hygiene conditions and appendicitis after controlling for diet (e.g., Coggon et al, 1991; Li et al, 2018). For example, children living in areas with low‐piped water supply were found to have a higher risk of appendicitis than their counterparts living in areas of higher piped water supply, suggesting that access to clean water during childhood may actually protect against appendicitis (Li et al, 2018).…”

“…Additionally, subsequent studies have directly refuted the correlation between good hygiene conditions and appendicitis after controlling for diet (e.g., Coggon et al, 1991; Li et al, 2018). For example, children living in areas with low‐piped water supply were found to have a higher risk of appendicitis than their counterparts living in areas of higher piped water supply, suggesting that access to clean water during childhood may actually protect against appendicitis (Li et al, 2018). Similarly, subjects born into households with amenities such as hot water, piped water, and bathrooms were found to have lower risk of appendectomy than members of the same population who grew up in houses lacking these amenities (Coggon et al, 1991).…”

Evaluation of some cellular biomarker proteins, oxidative stress and clinical indices as results of laparoscopic appendectomy for perforated appendicitis in children

“…In fact, it is a progressive disease, which is caused by acute inflammation secondary to appendiceal orifice obstruction, thus leading to necrosis and perforation of the appendix wall. Inadequate treatment will also lead to a higher incidence of perforated appendicitis (2,3). Appendectomy has always been the first choice for clinical treatment of appendicitis, but there are more postoperative complications (4).…”