Ameloblastoma at a Tertiary Referral Hospital: Spatial Distribution and Area-Level Sociodemographics in South Sulawesi

Abstract

BACKGROUND: Ameloblastoma is a locally aggressive odontogenic tumour whose reported occurrence varies geographically. In South Sulawesi, Indonesia, epidemiological data remain scarce and district-level disparities are undocumented. This study mapped the residential distribution of patients treated at a tertiary referral hospital and examined area-level correlates of that distribution. METHODS: An analytical ecological study used the 24 districts/cities of South Sulawesi as spatial units. All histopathologically confirmed cases (n = 160, 2022-2024) were attributed to district of residence and ecologically associated with district-level health system capacity and socioeconomic indicators. Spatial distribution was assessed by choropleth mapping with Jenks classification, and population-adjusted rates per 100,000 were calculated. Differences across urban, peri-urban, and rural groupings were evaluated using Kruskal-Wallis and pairwise Poisson tests, and ecological associations using Pearson's correlation and exploratory geographically weighted regression. RESULTS: Cases concentrated in the southwestern corridor, mainly in urban areas. Parepare recorded the highest reported case rate (15.54 per 100,000), whereas Makassar ranked sixth (1.84 per 100,000). Urban (rate ratios = 3.27) and peri-urban (rate ratios = 3.59) districts showed higher rates than rural districts (both P < .001), although the Kruskal-Wallis omnibus test was not significant (P = .076), plausibly reflecting limited power with unequal group sizes. Reported rates correlated strongly with health system capacity indicators (r ≈ 0.83-0.89; P < .0001), negatively with poverty (r = -0.493) and positively with expenditure, schooling and unemployment (r = 0.617-0.698; P < .01), reflecting ecological patterns of case detection rather than individual risk. Exploratory geographically weighted regression indicated spatial nonstationarity, with 22 districts showing at least one locally significant socioeconomic variable. CONCLUSION: Reported ameloblastoma rates concentrate in urban referral centres and track health system capacity, indicating patterns of case detection and diagnostic access rather than true disease occurrence. These hypothesis-generating findings support district-specific strategies to improve diagnostic equity rather than uniform interventions.

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