{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:59:44Z","timestamp":1776923984341,"version":"3.51.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Acute pancreatitis (AP) is a well-recognized digestive emergency with established clinical significance. However, current evidence regarding urban\u2013rural 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This 20-year retrospective cohort study (2005\u20132024) analyzed 12,214 acute pancreatitis (AP) cases from a tertiary medical center to investigate urban\u2013rural disparities in etiology and clinical outcomes. Patients were stratified into urban (<jats:italic>n<\/jats:italic>\u202f=\u202f5,002) and rural (<jats:italic>n<\/jats:italic>\u202f=\u202f7,212) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Urban patients exhibited a rising burden of hypertriglyceridemia-induced AP (HTG-AP; 30.6% vs. rural 26.3%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), surpassing biliary AP as the dominant etiology by 2023, while rural populations maintained higher biliary AP prevalence (56.4% vs. 51.7%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Rural patients demonstrated prolonged symptom-to-admission intervals (median 3 vs. 2\u202fdays), elevated APACHE II scores (8 vs. 7), and increased severe AP incidence (20.7% vs. 18.3%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.01), 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\u202f=\u202f1.13, <jats:italic>p<\/jats:italic>\u202f=\u202f0.005), alongside hypertriglyceridemia (aOR\u202f=\u202f2.06) and delayed admission (aOR\u202f=\u202f1.01\/day). Temporal trends revealed accelerated HTG-AP growth post-2020 in both groups, paralleling metabolic syndrome escalation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings underscore the imperative for dual interventions: urban-focused metabolic risk mitigation and rural-targeted biliary disease management, informed by evolving etiological landscapes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1640267","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T05:24:15Z","timestamp":1752729855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Etiological shifts and clinical outcomes of acute pancreatitis between urban and rural areas: evidence from a 20-year retrospective database"],"prefix":"10.3389","volume":"12","author":[{"given":"Ximei","family":"Cao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zide","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwen","family":"Rao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Xia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingyu","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Shu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nonghua","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenhua","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1038\/s41575-018-0087-5","article-title":"Global epidemiology and holistic prevention of pancreatitis","volume":"16","author":"Petrov","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1053\/j.gastro.2018.12.041","article-title":"Organ failure due to systemic injury in acute pancreatitis","volume":"156","author":"Garg","year":"2019","journal-title":"Gastroenterology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1053\/j.gastro.2024.02.052","article-title":"Diagnosis and Management of Acute Pancreatitis","volume":"167","author":"Trikudanathan","year":"2024","journal-title":"Gastroenterology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3781","DOI":"10.12114\/j.issn.1007-9572.2021.02.028","article-title":"Expert consensus on diagnosis and treatment of hypertriglyceridemic acute pancreatitis in emergency medicine","volume":"24","year":"2021","journal-title":"Chin Gen Pract"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3877\/cma.j.issn.2095-2015.2016.02.006","article-title":"Meta-analysis of the etiological changes of acute pancreatitis in China over the past decade","volume":"6","author":"Zhang","year":"2016","journal-title":"Chin J Dig Dis Imaging (Electron Ed)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1097\/mpa.0000000000000776","article-title":"A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised Atlanta classification in Jiangxi, China over an 8-year period","volume":"46","author":"Zhu","year":"2017","journal-title":"Pancreas"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1053\/j.gastro.2021.09.043","article-title":"Global incidence of acute pancreatitis is increasing over time: a systematic review and meta-analysis","volume":"162","author":"Iannuzzi","year":"2022","journal-title":"Gastroenterology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/s0140-6736(14)60649-8","article-title":"Acute pancreatitis","volume":"386","author":"Lankisch","year":"2015","journal-title":"Lancet"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3996","DOI":"10.3748\/wjg.v30.i35.3996","article-title":"Impact of metabolic syndrome components on clinical outcomes in hypertriglyceridemia-induced acute pancreatitis","volume":"30","author":"Fu","year":"2024","journal-title":"World J Gastroenterol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.hbpd.2020.10.003","article-title":"Trends and seasonality in hospitalizations for acute alcohol-related and biliary pancreatitis in the USA","volume":"20","author":"Shmelev","year":"2021","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1186\/s12889-020-08896-y","article-title":"Association between diet-related knowledge, attitudes, behaviors, and self-rated health in Chinese adult residents: a population-based study","volume":"20","author":"Yang","year":"2020","journal-title":"BMC Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"10.3390\/foods12101997","DOI":"10.3390\/foods12101997","article-title":"The reasonableness and spatial differences of the food consumption structure of urban and rural residents in China, 2015-2021","volume":"12","author":"Lian","year":"2023","journal-title":"Food Secur"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1420590","DOI":"10.1155\/2018\/1420590","article-title":"Epidemiology and etiology of acute pancreatitis in urban and suburban areas in Shanghai: a retrospective study","volume":"2018","author":"Fan","year":"2018","journal-title":"Gastroenterol Res Pract"},{"key":"ref14","article-title":"Scientific Research Report on Chinese Dietary Guidelines","year":"2021"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ijsu.2015.08.080","article-title":"Acute pancreatitis associated with severe hypertriglyceridaemia; a retrospective cohort study","volume":"23","author":"Charlesworth","year":"2015","journal-title":"Int J Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1002\/bjs.7632","article-title":"Effect of type of alcoholic beverage in causing acute pancreatitis","volume":"98","author":"Sadr Azodi","year":"2011","journal-title":"Br J Surg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12939-016-0330-z","article-title":"Large urban-rural disparity in the severity of two-week illness: updated results based on the first health service survey of Hunan Province, China","volume":"15","author":"Tian","year":"2016","journal-title":"Int J Equity Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1007\/s10620-023-08172-0","article-title":"Etiological changes and prognosis of hospitalized patients with acute pancreatitis over a 15-year period","volume":"69","author":"Lai","year":"2024","journal-title":"Dig Dis Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"976816","DOI":"10.3389\/fcimb.2022.976816","article-title":"Elevated hypertriglyceridemia and decreased gallstones in the etiological composition ratio of acute pancreatitis as affected by seasons and festivals: a two-center real-world study from China","volume":"12","author":"He","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.jss.2011.05.031","article-title":"An urban-rural blight? Choledocholithiasis presentation and treatment","volume":"173","author":"Shelton","year":"2012","journal-title":"J Surg Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s12876-023-02868-3","article-title":"Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations","volume":"23","author":"Li","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1053\/j.gastro.2020.07.016","article-title":"Analysis of 1060 cases of drug-induced acute pancreatitis","volume":"159","author":"Meczker","year":"2020","journal-title":"Gastroenterology"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1002\/cpt.3139","article-title":"Drug-induced acute pancreatitis: a real-world pharmacovigilance study using the FDA adverse event reporting system database","volume":"115","author":"Li","year":"2024","journal-title":"Clin Pharmacol Ther"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/1475-9276-13-34","article-title":"Suggestions to ameliorate the inequity in urban\/rural allocation of healthcare resources in China","volume":"13","author":"Chen","year":"2014","journal-title":"Int J Equity Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"89","DOI":"10.4103\/cjrm.cjrm_12_24","article-title":"Rural-urban differences in wait-time to general surgical outpatient care","volume":"30","author":"Cowan","year":"2025","journal-title":"Can J Rural Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s12939-022-01734-0","article-title":"Difference in bypass for inpatient care and its determinants between rural and urban residents in China","volume":"21","author":"Lu","year":"2022","journal-title":"Int J Equity Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1053\/j.gastro.2018.01.031","article-title":"Initial medical treatment of acute pancreatitis: American Gastroenterological Association Institute technical review","volume":"154","author":"Vege","year":"2018","journal-title":"Gastroenterology"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1364584","DOI":"10.3389\/fpubh.2024.1364584","article-title":"Effectiveness of hierarchical medical system and economic growth: based on China's urban vs. rural health perspectives","volume":"12","author":"Zhao","year":"2024","journal-title":"Front Public Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1186\/s12889-021-11573-3","article-title":"Urban-rural differences in healthcare utilization among beneficiaries in China's new cooperative medical scheme","volume":"21","author":"Luo","year":"2021","journal-title":"BMC Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"l6227","DOI":"10.1136\/bmj.l6227","article-title":"Management of severe acute pancreatitis","volume":"367","author":"Hines","year":"2019","journal-title":"BMJ"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"885013","DOI":"10.3389\/fpubh.2022.885013","article-title":"Effects of coronavirus disease 2019 lockdown on metabolic syndrome and its components among Chinese employees: a retrospective cohort study","volume":"10","author":"Xu","year":"2022","journal-title":"Front Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1186\/s12967-022-03407-6","article-title":"Causal relationship between physical activity, leisure sedentary behaviors and COVID-19 risk: a Mendelian randomization study","volume":"20","author":"Chen","year":"2022","journal-title":"J Transl Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1640267\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T05:24:19Z","timestamp":1752729859000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1640267\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,17]]},"references-count":33,"alternative-id":["10.3389\/fmed.2025.1640267"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1640267","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,17]]},"article-number":"1640267"}}