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Open AccessArticle

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

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Department of Radiology, E-Da Hospital, I-Shou university, Kaohsiung 824, Taiwan
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Department of Radiology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung 802, Taiwan
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Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
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College of Medicine, China Medical University, Taichung 404, Taiwan
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Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
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Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 404, Taiwan
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Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(8), 1601; https://doi.org/10.3390/ijerph15081601
Received: 12 June 2018 / Revised: 24 July 2018 / Accepted: 25 July 2018 / Published: 28 July 2018
(This article belongs to the Special Issue Water, Sanitation and Hygiene Related Disease)
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. View Full-Text
Keywords: child health; hygiene; appendicitis; piped water; epidemiology child health; hygiene; appendicitis; piped water; epidemiology
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MDPI and ACS Style

Li, H.-M.; Liu, S.-Z.; Huang, Y.-K.; Su, Y.-C.; Kao, C.-H. Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study. Int. J. Environ. Res. Public Health 2018, 15, 1601.

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