Reduction in perforated appendicitis incidence between rural and urban populations after introducing social health insurance in Vietnam: A population-based study.

Abstract

Over the years, Vietnam has expanded its social health insurance (SHI) coverage to reduce health disparities. In this population-based study, we examined the differences in incidences of perforated appendix between rural and urban populations in Vietnam since the expansion of SHI coverage in 2015. We also identified risk factors for perforated appendix in these populations. The 2015-2019 SHI inpatient claims data from the Social Security Agency of Dong Thap Province were used to elaborate the final sample of 6863 patients aged 18 years or above who underwent an appendectomy. Multivariable probit and logistic regression model were employed to obtain adjusted estimates. An overall rate of 22.9% for perforated appendix among adults in Dong Thap was revealed. After the expansion of SHI, rural residents consistently had lower rates of perforated appendix than urban residents, but the differences between rural and urban residents were small and decreased over time, that is from 4.4% in 2015 to 3.4% in 2019. Older, male, and poor residents were at a higher risk of perforated appendix in both urban and rural areas. In rural areas, patients with comorbidities, patients who resided in remote communes bordering Cambodia, and patients who had district hospitals or commune facilities as their primary assigned providers were significantly more likely to develop perforated appendix. Under the SHI in Vietnam, no significant difference was observed in perforated appendicitis incidence between urban and rural residents. Additional efforts are required to reduce poorer outcomes among other high-risk residents.