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. 2024 Sep;9(9):825-858.
doi: 10.1016/S2468-1253(24)00157-2. Epub 2024 Jul 17.

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

GBD 2021 Appendicitis Collaborator Group
Collaborators

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

GBD 2021 Appendicitis Collaborator Group. Lancet Gastroenterol Hepatol. 2024 Sep.

Abstract

Background: Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021.

Methods: Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs).

Findings: In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates.

Interpretation: Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions.

Funding: Bill and Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests M Lee reports support for the present manuscript from the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2023S1A3A2A05095298) and Bio-convergence Technology Education Program through the Korea Institute for Advancement Technology (KIAT) funded by the Ministry of Trade, Industry and Energy (No. P0017805). M-C Li reports grants or contracts from the National Science and Technology Council in Taiwan (NSTC 112-2410-H-003-031); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Journal of the American Heart Association as a Technical Editor; outside the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. J Sanabria reports support for attending meetings and/or travel from Marshall University School of Medicine; Participation on a Data Safety Monitoring Board or Advisory Board from Marshall University School of Medicine; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with SSO, SSAT, AASLD, IHPBA, ACS, and ABS; outside the submitted work. JA Singh reports consulting fees from ROMTech, Atheneum, Clearview healthcare partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs, Adept Field Solutions, Clinical Care options, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications; and the National Institutes of Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events on the speakers bureau of Simply Speaking; support for attending meetings and/or travel from OMERACT as a steering committee member; participation on a data safety monitoring board or advisory board with the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid as a past steering committee member of the OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, unpaid as Chair of the Veterans Affairs Rheumatology Field Advisory Committee, and unpaid as the Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis; stock or stock options in Atai life sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona Pharmaceuticals, and Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals outside the submitted work. JHV Ticoalu reports other financial or non-financial interests as a co-founder of Benang Merah Research Center outside the submitted work. The other authors declare no competing interests.

Figures

Figure 1
Figure 1
Percentage change in deaths and incidence due to appendicitis between 1990 and 2021, globally and for 21 GBD regions, for both sexes combined Circles represent the mean percentage change between 1990 and 2021. The lines represent the 95% uncertainty interval of the mean. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 2
Figure 2
Spatial distribution of the appendicitis burden at all ages and in both sexes, 2021 (A) Age-standardised cause-specific mortality rates of appendicitis in 2021, per 100 000. (B) Age-standardised incidence rates of appendicitis in 2021, per 100 000.
Figure 3
Figure 3
Age-standardised rates of appendicitis mortality and incidence in 2021 (A) Based on Socio-demographic Index, colour-coded by GBD super-region. (B) Based on Healthcare Access and Quality Index, colour-coded by GBD super-region. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 4
Figure 4
Global temporal trend of DALYs due to appendicitis between 1990 and 2021 The black line represents the total DALY counts in millions, with the grey shading representing the 95% uncertainty intervals. The red line represents the total DALY counts in millions, with the light red shading representing the 95% uncertainty intervals. DALYs=disability-adjusted life-years.
Figure 5
Figure 5
Distribution of absolute DALYs due to appendicitis in 2021 by age group, sex, and GBD super-region DALYs=disability-adjusted life-years. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
See this image and copyright information in PMC

References

    1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–925. - PubMed
    1. Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995–2009. World J Surg. 2012;36:2787–2794. - PubMed
    1. Sartelli M, Baiocchi GL, Di Saverio S, et al. Prospective observational study on acute appendicitis worldwide (POSAW) World J Emerg Surg. 2018;13:19. - PMC - PubMed
    1. Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11 - PMC - PubMed
    1. Frazee RC, Abernathy SW, Davis M, et al. Outpatient laparoscopic appendectomy should be the standard of care for uncomplicated appendicitis. J Trauma Acute Care Surg. 2014;76:79–82. - PubMed

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