ORIGINAL RESEARCH article
Front. Med.
Sec. Gastroenterology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1640267
Etiological Shifts and Clinical Outcomes of Acute Pancreatitis Between Urban and Rural Areas: Evidence From a 20-Year Retrospective Database
Provisionally accepted
Ximei Cao1
Zide Liu2Jingwen Rao2Jie Wu2Xin Huang2Liang Xia2Lingyu Luo2
Xu Shu2
Yin Zhu2
Nonghua Lu2
Wenhua He2*- 1Jiujiang First People's Hospital, Jiujiang, China
- 2The First Affiliated Hospital of Nanchang University, Nanchang, China
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Background: Acute pancreatitis (AP) is a well-recognized digestive emergency with established clinical significance. However, current evidence regarding urban-rural distribution patterns of AP patients remains relatively limited. Through large-scale data analysis, this study aims to provide preliminary epidemiological references for this understudied area.Methods: This 20-year retrospective cohort study (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024) analyzed 12,214 acute pancreatitis (AP) cases from a tertiary medical center to investigate urban-rural disparities in etiology and clinical outcomes. Patients were stratified into urban (n = 5,002) and rural (n = 7,212) groups based on residential location. We compared demographic characteristics, etiological distributions, disease severity, complications, and hospitalization outcomes between the groups. Risk factors for moderate-to-severe AP were assessed using multivariable logistic regression, with adjustment for demographic, clinical, and temporal covariates.Results: Urban patients exhibited a rising burden of hypertriglyceridemia-induced AP (HTG-AP; 30.6% vs. rural 26.3%, P<0.001), surpassing biliary AP as the dominant etiology by 2023, while rural populations maintained higher biliary AP prevalence (56.4% vs. 51.7%, P<0.001). Rural patients demonstrated prolonged symptom-to-admission intervals (median 3 vs. 2 days), elevated APACHE II scores (8 vs. 7), and increased severe AP incidence (20.7% vs. 18.3%, P<0.01), with higher risks of infected pancreatic necrosis (5.3% vs. 4.3%) and abdominal compartment syndrome (1.7% vs. 1.1%). Multivariable analysis suggested that rural group may be associated with increased risk of moderate-to-severe AP (aOR=1.13, P=0.005), alongside hypertriglyceridemia (aOR=2.06) and delayed admission (aOR=1.01/day). Temporal trends revealed accelerated HTG-AP growth post-2020 in both groups, paralleling metabolic syndrome escalation.These findings underscore the imperative for dual interventions: urban-focused metabolic risk mitigation and rural-targeted biliary disease management, informed by evolving etiological landscapes.
Keywords: acute pancreatitis, Urban-rural disparities, biliary, Hypertriglyceridemic, severity propensity
Received: 03 Jun 2025; Accepted: 04 Jul 2025.
Copyright: © 2025 Cao, Liu, Rao, Wu, Huang, Xia, Luo, Shu, Zhu, Lu and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenhua He, The First Affiliated Hospital of Nanchang University, Nanchang, China
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