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

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.

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.

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.

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.