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. 2025 Sep;49(9):2399-2408.
doi: 10.1002/wjs.70023. Epub 2025 Jul 28.

Trends and Disparities in Appendicitis-Related Mortality Across U.S. Demographics and Regions: A 22-Year CDC WONDER Database Study

Rayyan Nabi  1 , Shree Rath  2 , Sohaib Aftab Ahmad Chaudhry  3 , Najaf Ahmed Rajpar  4 , Sabahat Ul Ain Munir Abbasi  5 , Tabeer Zahid  6 , Raheel Ahmed  7
Affiliations

Trends and Disparities in Appendicitis-Related Mortality Across U.S. Demographics and Regions: A 22-Year CDC WONDER Database Study

Rayyan Nabi et al. World J Surg. 2025 Sep.

Abstract

Background: Appendicitis remains a common surgical emergency with potentially fatal complications. Long-term trends in mortality disparities are not well characterized. We analyzed demographic and regional disparities in appendicitis-related mortality in the United States from 1999 to 2020 using CDC WONDER data.

Methods: We performed a retrospective analysis of death-certificate data for individuals aged ≥ 25 years, identifying appendicitis-related deaths (ICD-10 K35-K37). Age-adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 U.S.

Standard: Joinpoint regression estimated annual percentage changes (APCs) and average APCs (AAPCs) with 95% confidence intervals. Analyses were stratified by sex, race/ethnicity, urbanization, and state.

Results: From 1999 to 2020, 15,243 appendicitis-related deaths occurred (6643 females and 8600 males). Overall AAMR declined from 0.38 to 0.32 per 100,000 (AAPC -1.38% and 95% CI -3.10 to 0.36). A significant decrease occurred from 1999 to 2018 (APC-2.81% and p < 0.0001), followed by a nonsignificant rise. Males exhibited a consistent decline (AAPC -2.88% and p < 0.0001), whereas females experienced an increase from 2016 to 2020 (APC +5.94% and p < 0.0001). Black individuals had the highest AAMR (0.38) but a significant decline (AAPC -3.73% and p < 0.0001) compared to Whites (AAPC -2.49% and p < 0.0001) and Hispanics (AAPC -2.06% and p < 0.0001). Nonmetropolitan areas had higher AAMR (0.34) than metropolitan areas (0.31). Vermont and New Mexico recorded the highest state-level AAMRs; New Jersey and Louisiana had the lowest.

Conclusions: Appendicitis-related mortality in the United States declined over two decades; however, rising mortality among females since 2016 and persistent racial and regional disparities underscore the need for targeted interventions to ensure equitable access to timely surgical care.

Keywords: CDC wonder; appendicitis; emergency care; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
AAMR‐related to appendicitis in the United States by sex, 1999–2020.
FIGURE 2
FIGURE 2
AAMR‐related to appendicitis in the United States by race, 1999–2020.
FIGURE 3
FIGURE 3
AAMR‐related to appendicitis in the United States by metropolitan status, 1999–2020.
FIGURE 4
FIGURE 4
AAMR‐related to appendicitis in the United States by state, 1999–2020.
FIGURE 5
FIGURE 5
Central illustration showing summary of results.
See this image and copyright information in PMC

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