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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 Publisher Pubmed



Han H1 ; Letourneau ID1, 19 ; Abate YH5, 23 ; Abdelmasseh M135, 168 ; Abugharbieh E7, 9, 25, 27 ; Adane TD10, 28 ; Ahinkorah BO11, 29 ; Ahmad A12, 30 ; Ahmadi A13, 14, 31, 32 ; Ahmed A38, 39 ; Alhalaiqa FN40, 41 ; Alsabah SK42, 43 ; Alworafi YM44, 45 ; Amu H46 Show All Authors
Authors
  1. Han H1
  2. Letourneau ID1, 19
  3. Abate YH5, 23
  4. Abdelmasseh M135, 168
  5. Abugharbieh E7, 9, 25, 27
  6. Adane TD10, 28
  7. Ahinkorah BO11, 29
  8. Ahmad A12, 30
  9. Ahmadi A13, 14, 31, 32
  10. Ahmed A38, 39
  11. Alhalaiqa FN40, 41
  12. Alsabah SK42, 43
  13. Alworafi YM44, 45
  14. Amu H46
  15. Andrei CL47
  16. Anoushiravani A49
  17. Arabloo J55
  18. Aravkin AY1, 2, 3, 19, 21
  19. Ashraf T4
  20. Azadnajafabad S61, 148
  21. Baghcheghi N62
  22. Bagherieh S22
  23. Bantie BB65
  24. Bardhan M66, 80, 195
  25. Basile G60
  26. Bayleyegn NS69
  27. Behnoush AH76
  28. Bekele A71
  29. Bhojaraja VS73
  30. Bijani A74
  31. Biondi A67
  32. Burkart K1, 3, 19, 21
  33. Chu DT75
  34. Chukwu IS99
  35. Cruzmartins N77, 78
  36. Dai X1, 3, 19, 21
  37. Demessa BH79
  38. Dhali A108
  39. Diaz D81
  40. Do TC82
  41. Dodangeh M56
  42. Dongarwar D84
  43. Dsouza HL85, 87
  44. Ekholuenetale M88
  45. Ekundayo TC89
  46. Sayed IE90
  47. Elhadi M91, 92
  48. Fagbamigbe AF93, 94
  49. Fakhradiyev IR95
  50. Ferrara P96
  51. Fetensa G97
  52. Fischer F98
  53. Gebrehiwot M112
  54. Getachew M100
  55. Golechha M101
  56. Gupta VK102
  57. Habib JR103
  58. Hadi NR104
  59. Haep N105, 106
  60. Haile TG35
  61. Hamilton EB35
  62. Hasan I35
  63. Hasani H57
  64. Hassanzadeh S64
  65. Haubold J109, 110
  66. Hay SI40
  67. Hayat K111, 122
  68. Ilesanmi OS113, 114
  69. Inamdar S115
  70. Iwu CCD116
  71. Iyasu AN41
  72. Jayarajah U117, 118
  73. Jayaram S119
  74. Jokar M120, 121
  75. Jomehzadeh N122, 123
  76. Joseph A124
  77. Joseph N125
  78. Joshua CE126
  79. Kabir A58
  80. Kandel H127, 128
  81. Kauppila JH129, 130
  82. Bohan PMK131
  83. Khajuria H132
  84. Khan M133
  85. Khatatbeh H134
  86. Kim MS135
  87. Kisa A136, 137
  88. Kompani F51
  89. Koohestani HR63
  90. Kumar R138
  91. Le TTT139
  92. Lee M140, 141, 142
  93. Lee SW140, 141
  94. Li MC142
  95. Lim SS1, 3, 19, 21
  96. Lo CH143
  97. Lunevicius R144, 145
  98. Malhotra K146, 147
  99. Maugeri A68
  100. Mediratta RP149
  101. Meretoja TJ150, 151
  102. Mestrovic T1, 19, 152
  103. Mirzaaghazadehattari M155
  104. Mohamed NS157, 158
  105. Mokdad AH1, 3, 19, 21
  106. Monasta L159
  107. Moni MA160
  108. Moradi M59
  109. Mougin V1, 19
  110. Mukoro GD161
  111. Murillozamora E162, 163
  112. Murray CJL38
  113. Naimzada MD164, 165
  114. Najmuldeen HHR166
  115. Natto ZS167, 168
  116. Negoi I48, 169
  117. Nguyen HQ170
  118. Nikolouzakis TK171, 172
  119. Olufadewa II93, 173
  120. Padubidri JR200
  121. Pandey A175, 176
  122. Parikh RR177
  123. Pham HT83
  124. Pollok RCG179
  125. Rahimi M154
  126. Rahimimovaghar V19
  127. Rahman M180
  128. Rahmani S15, 33
  129. Rashidi MM16, 34, 53
  130. Rawaf S181, 182
  131. Rickard J178, 183
  132. Rouientan H17, 18, 35, 36
  133. Roy S184
  134. Saddik BA8, 26, 185
  135. Saeed U186, 187
  136. Saleh MA8, 26, 188
  137. Salehi S189
  138. Samy AM190
  139. Sanabria J6, 24, 191
  140. Sankararaman S192, 193
  141. Schumacher AE1, 19
  142. Senthilkumaran S194
  143. Shah PA26
  144. Shool S21, 37, 52
  145. Sibhat MM196
  146. Sidamo NB72
  147. Singh JA197, 198
  148. Socea B48, 50, 70, 199
  149. Solomon Y176
  150. Sreeram S86
  151. Tabatabaei SM34, 37
  152. Tan KK33
  153. Tavangar SM54
  154. Tefera YM25
  155. Thomas NK31
  156. Ticoalu JHV30
  157. Tsegay GM107
  158. Tsegaye D29
  159. Ullah S26, 28
  160. Usman AN24
  161. Valizadeh R156
  162. Veroux M68
  163. Verras GI20, 23
  164. Vos T1, 3, 19, 21
  165. Wang M36
  166. Wang S36
  167. Wickramasinghe DP117
  168. Yahya G32, 174
  169. Zare I17
  170. Zarrintan A153
  171. Zhang ZJ22
  172. Dirac MA3
Show Affiliations
Authors Affiliations
  1. 1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  2. 2. Department of Applied Mathematics, University of Washington, Seattle, WA, United States
  3. 3. Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
  4. 4. Department of Family Medicine, University of Washington, Seattle, WA, United States
  5. 5. Department of Clinical Governance and Quality Improvement, Aleta Wondo Hospital, Aleta Wondo, Ethiopia
  6. 6. Department of Surgery, Marshall University, Huntington, WV, United States
  7. 7. Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
  8. 8. College of Medicine, University of Sharjah, United Arab Emirates
  9. 9. Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan
  10. 10. Department of Clinical and Psychosocial Epidemiology, University of Groningen, Groningen, Netherlands
  11. 11. School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
  12. 12. Department of Medical Biochemistry, Shaqra University, Shaqra, Saudi Arabia
  13. 13. Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  14. 14. Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  15. 15. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  16. 16. Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  17. 17. Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  18. 18. Department of Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  19. 19. Institute of Institute for Health Metrics and Evaluation, United States
  20. 20. College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
  21. 21. Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  22. 22. School of Public Health, Wuhan University, Wuhan, China
  23. 23. Department of Surgery, General University Hospital of Patras, Patras, Greece
  24. 24. Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
  25. 25. Department of Public Health, Dire Dawa University, Dire Dawa, Ethiopia
  26. 26. Department of Pathology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
  27. 27. Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan
  28. 28. Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
  29. 29. Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
  30. 30. Faculty of Public Health, Universitas Sam Ratulangi (Sam Ratulangi University), Manado, Indonesia
  31. 31. Department of Gastroenterology, St Luke's Hospital, Pathanamthitta, India
  32. 32. Department of Cells and Tissues, Molecular Biology Institute of Barcelona, Barcelona, Spain
  33. 33. Department of Surgery, National University of Singapore, Singapore, Singapore
  34. 34. Clinial Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran
  35. 35. Research and Development Department, Sina Medical Biochemistry Technologies, Shiraz, Iran
  36. 36. Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
  37. 37. Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran
  38. 38. Institute of Endemic Diseases, University of Khartoum, Sudan
  39. 39. Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
  40. 40. College of Nursing, Qatar University, Doha, Qatar
  41. 41. Psychological Sciences Association, Amman, Jordan
  42. 42. Department of Surgery, Kuwait University, Kuwait, Kuwait
  43. 43. Jaber Al Ahmad Al Sabah Hospital, Ministry of Health, Kuwait
  44. 44. Department of Medical Sciences, Azal University for Human Development, Sana'a, Yemen
  45. 45. Department of Clinical Sciences, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
  46. 46. Department of Population and Behavioural Sciences, University of Health and Allied Sciences, Ho, Ghana
  47. 47. Department of Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  48. 48. Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  49. 49. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  50. 50. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  51. 51. Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  52. 52. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  53. 53. Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  54. 54. Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran
  55. 55. Health Management and Economics Research Center
  56. 56. School of Medicine, Tehran, Iran
  57. 57. Department of Ophthalmology, Tehran, Iran
  58. 58. Minimally Invasive Surgery Research Center, Tehran, Iran
  59. 59. Iran University of Medical Sciences, Tehran, Iran
  60. 60. University Institute of Radiological Sciences and Medical Imaging Technology, The University of Lahore, Lahore, Pakistan
  61. 61. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
  62. 62. Department of Nursing, Saveh University of Medical Sciences, Saveh, Iran
  63. 63. Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
  64. 64. School of Medicine Isfahan University of Medical Sciences, Isfahan, Iran
  65. 65. Department of Comprehensive Nursing, Debre Tabor University, Debre Tabor, Ethiopia
  66. 66. Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
  67. 67. Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
  68. 68. Department of Medical and Surgical Sciences and Advanced Technologies Gf Ingrassia, University of Catania, Catania, Italy
  69. 69. Department of Surgery, Jimma University, Jimma, Ethiopia
  70. 70. Non-Communicable Diseases Research Center (NCDRC) Tehran, Iran, Iran
  71. 71. Department of Medical Anatomy, Arba Minch University, Arba Minch, Ethiopia
  72. 72. School of Public Health, Arba Minch University, Arba Minch, Ethiopia
  73. 73. Department of Anatomy, Royal College of Surgeons in Ireland Medical, University of Bahrain, Busaiteen, Bahrain
  74. 74. Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  75. 75. Center for Biomedicine and Community Health, Vietnam National University Hanoi (VNUIS) Hanoi, Viet Nam
  76. 76. Department of Paediatric Surgery, Federal Medical Centre, Umuahia, Nigeria
  77. 77. Department of Diagnostic and Therapeutic Technologies, Coop. de Ensino Sup. Politec. e Univ. (Polytech. and Univ. Higher Educ. Coop.), Vila Nova de Famalicao, Portugal
  78. 78. Institute for Research and Innovation in Health (I3S), University of Porto, Porto, Portugal
  79. 79. Jimma University, USAID-JSI Digital Health Activity, Addis Ababa, Ethiopia
  80. 80. Sheffield Teaching Hospitals Nhs Foundation Trust, Sheffield, United Kingdom
  81. 81. Faculty of Science, National Autonomous University of Mexico, Mexico City, Mexico
  82. 82. Department of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
  83. 83. School of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
  84. 84. Health Science Center, University of Texas, Houston, TX, United States
  85. 85. Manipal Academy of Higher Education, Manipal Academy of Higher Education, Manipal, India
  86. 86. Department of Pathology, Manipal Academy of Higher Education, Manipal, India
  87. 87. Department of Forensic Medicine and Toxicology, Kasturba Medical College Mangalore, Mangalore, India
  88. 88. Faculty of Science and Health, University of Portsmouth, Hampshire, United Kingdom
  89. 89. Department of Microbiology, University of Medical Sciences, Ondo, Nigeria
  90. 90. Biomedical Informatics and Medical Statistics Department, Alexandria University, Alexandria, Egypt
  91. 91. Faculty of Medicine, University of Tripoli, Tripoli, Libya
  92. 92. Houston Methodist Hospital, Houston, TX, United States
  93. 93. Department of Epidemiology and Medical Statistics, Faculty of Public Health University of Ibadan, Ibadan, Nigeria
  94. 94. Research Centre for Healthcare and Community, Coventry University, Coventry, United Kingdom
  95. 95. Kazakh National Medical University, Scientific and Technological Park, Almaty, Kazakhstan
  96. 96. Research Center on Public Health, University of Milan Bicocca, Monza, Italy
  97. 97. Department of Nursing, Wollega University, Nekemte, Ethiopia
  98. 98. Institute of Public Health, Charite Universitatsmedizin Berlin, Berlin, Germany
  99. 99. Department of Environmental Health, Wollo University, Dessie, Ethiopia
  100. 100. Department of Emergency and Critical Care Medicine, Haramaya University, Harar, Ethiopia
  101. 101. Department of Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
  102. 102. Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
  103. 103. Department of Surgery, University of Maryland, New York, NY, United States
  104. 104. Department of Clinical Pharmacology and Medicine, University of Kufa, Najaf, Iraq
  105. 105. Department of Surgery, Charite Medical University Berlin, Berlin, Germany
  106. 106. Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany
  107. 107. Department of Nursing, Aksum University, Aksum, Ethiopia
  108. 108. Department of Pharmaceutical Technology, University of Dhaka, Dhaka, Bangladesh
  109. 109. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
  110. 110. Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
  111. 111. Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
  112. 112. Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
  113. 113. Africa Centre for Disease Control and Prevention, University of Ibadan, Abuja, Nigeria
  114. 114. Department of Community Medicine, University College Hospital, Ibadan, Nigeria
  115. 115. Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
  116. 116. School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
  117. 117. Department of Surgery, Colombo, Sri Lanka
  118. 118. Department of Surgery, National Hospital, Colombo, Sri Lanka
  119. 119. Department of Biochemistry, Government Medical College, Mysuru, India
  120. 120. Zoonoses Research Center, Islamic Azad University, Karaj, Iran
  121. 121. Jahrom University of Medical Sciences, Ahvaz, Iran
  122. 122. Department of Microbiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  123. 123. Department of Microbiology, Abadan School of Medical Sciences, Abadan, Iran
  124. 124. Department of Gastroenterology and Hepatology, Stanford University, Stanford, CA, United States
  125. 125. Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
  126. 126. Department of Economics, National Open University, Benin City, Nigeria
  127. 127. Save Sight Institute, University of Sydney, Sydney, NSW, Australia
  128. 128. Sydney Eye Hospital, South Eastern Sydney Local Health District, Sydney, NSW, Australia
  129. 129. Surgery Research Unit, University of Oulu, Oulu, Finland
  130. 130. Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
  131. 131. Department of Surgery, Brooke Army Medical Center, Seattle, WA, United States
  132. 132. Amity Institute of Forensic Sciences, Amity University, Noida, India
  133. 133. Department of Epidemiology, Jazan University, Jazan, Saudi Arabia
  134. 134. Faculty of Nursing, Jerash University, Jerash, Jordan
  135. 135. Broad Institute of Mit and Harvard, Cambridge, MA, United States
  136. 136. School of Health Sciences, Kristiania University College, Oslo, Norway
  137. 137. Department of International Health and Sustainable Development, Tulane University, New Orleans, LA, United States
  138. 138. College of Public Health and Health Informatics, University of Hail, Hail, Saudi Arabia
  139. 139. University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
  140. 140. Department of Medical Science, Ajou University School of Medicine, Suwon, South Korea
  141. 141. Department of Precision Medicine, Sungkyunkwan University, Suwon-si, South Korea
  142. 142. Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
  143. 143. Department of Internal Medicine, Kirk Kerkorian School of Medicine at Unlv, Las Vegas, NV, United States
  144. 144. Department of Emergency General and Trauma Surgery, Liverpool University Hospitals Nhs Foundation Trust, Liverpool, United Kingdom
  145. 145. Department of Surgery, University of Liverpool, Liverpool, United Kingdom
  146. 146. Rama Medical College Hospital and Research Centre, Uttar Pradesh, India
  147. 147. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  148. 148. School of Public Health, University of Adelaide, Adelaide, SA, Australia
  149. 149. Division of Pediatric Hospital Medicine, Stanford University, Palo Alto, CA, United States
  150. 150. Division of Breast Surgery, Helsinki University Hospital, Helsinki, Finland
  151. 151. University of Helsinki, Helsinki, Finland
  152. 152. University Centre Varazdin, University North, Varazdin, Croatia
  153. 153. Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
  154. 154. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  155. 155. Social Determinants of Health Center, Urmia, Iran
  156. 156. Urmia University of Medical Sciences, Urmia, Iran
  157. 157. Sirius Training and Research Centre, Molecular Biology Unit, Sudan
  158. 158. Sirius Training and Research Centre, Bio-Statistical and Molecular Biology Department, Khartoum, Sudan
  159. 159. Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  160. 160. Charles Sturt University, Bathurst, NSW, Australia
  161. 161. Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
  162. 162. Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Mexico
  163. 163. Universidad de Colima, Postgraduate in Medical Sciences, Colima, Mexico
  164. 164. Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
  165. 165. Experimental Surgery and Oncology Laboratory, Kursk State Medical University, Kursk, Russian Federation
  166. 166. Department of Medical Laboratory Analysis, Cihan University Sulaymaniya, Sulaymaniyah, Iraq
  167. 167. Department of Dental Public Health, King Abdulaziz University, Jeddah, Saudi Arabia
  168. 168. Department of Health Policy and Oral Epidemiology, Harvard University, Boston, MA, United States
  169. 169. Department of General Surgery, Emergency University Hospital Bucharest, Romania, Bucharest, Romania
  170. 170. Cardiovascular Research Department, Methodist Hospital, Merrillville, IN, United States
  171. 171. Department of General Surgery, University Hospital of Heraklion, Greece, Heraklion, Greece
  172. 172. Laboratory of Toxicology, University of Crete, Greece, Heraklion, Greece
  173. 173. Slum and Rural Health Initiative Research Academy, Slum and Rural Health Initiative, Ibadan, Nigeria
  174. 174. Department of Microbiology and Immunology, Zagazig University, Zagazig, Egypt
  175. 175. Research Department, Kathmandu, Nepal
  176. 176. Department of Nursing, Dire Dawa University, Dire Dawa, Ethiopia
  177. 177. Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
  178. 178. Department of Surgery, University of Minnesota, Minneapolis, MN, United States
  179. 179. Institute of Infection and Immunity, University of London, St George's, United Kingdom
  180. 180. Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
  181. 181. Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
  182. 182. Academic Public Health England, Public Health England, London, United Kingdom
  183. 183. Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
  184. 184. Department of Epidemiology, Florida International University, Miami, FL, United States
  185. 185. School of Population Health, University of New South Wales, Sydney, NSW, Australia
  186. 186. Clinical and Biomedical Research Center, Foundation University, Islamabad, Pakistan
  187. 187. International Center of Medical Sciences Research (ICMSR) Islamabad, Pakistan
  188. 188. Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
  189. 189. Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
  190. 190. Medical Ain Shams Research Institute (MASRI), Ain Shams University, Department of Entomology, Cairo, Egypt
  191. 191. Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, United States
  192. 192. Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
  193. 193. Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, United States
  194. 194. Emergency Department, Manian Medical Centre, Erode, India
  195. 195. Department of Microbiology, Rajiv Gandhi University of Health Sciences, Bangalore, India
  196. 196. Department of Pediatrics and Child Health Nursing, Dilla University, Dilla, Ethiopia
  197. 197. School of Medicine, University of Alabama at Birmingham, Houston, TX, United States
  198. 198. Us Department of Veterans Affairs (VA) Houston, Medicine Service, TX, United States
  199. 199. Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital Bucharest, Bucharest, Romania
  200. 200. Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, India

Source: The Lancet Gastroenterology and Hepatology Published:2024


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. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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