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
Hannah Han, Ian D Letourneau, Yohannes Abate, Michael Abdelmasseh, Eman Abu‐Gharbieh, Tigist Demssew Adane, Bright Opoku Ahinkorah, Aqeel Ahmad, Ali Ahmadi, Ayman Ahmed, Fadwa Alhalaiqa, Salman Khalifah Al-Sabah, Yaser Mohammed Al‐Worafi, Hubert Amu, Cătălina Liliana Andrei, Amir Anoushiravani, Jalal Arabloo, Aleksandr Y. Aravkin, Tahira Ashraf, Sina Azadnajafabad, Nayereh Baghcheghi, Sara Bagherieh, Berihun Bantie, Mainak Bardhan, Guido Basile, Nebiyou Simegnew Bayileyegn, Amir Hossein Behnoush, Alehegn Bekele, Vijayalakshmi S Bhojaraja, Ali Bijani, Antonio Biondi, Katrin Burkart, Dinh‐Toi Chu, Isaac Sunday Chukwu, Natália Martins, Xiaochen Dai, Berecha Hundessa Demessa, Arkadeep Dhali, Daniel Díaz, Thanh Chi, Milad Dodangeh, Deepa Dongarwar, Haneil Larson Dsouza, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Iman El Sayed, Muhammed Elhadi, Adeniyi Francis Fagbamigbe, Ildar Fakhradiyev, Pietro Ferrara, Getahun Fetensa, Florian Fischer, Mesfin Gebrehiwot, Melaku Getachew, Mahaveer Golechha, Vivek Gupta, Joseph R. Habib, Najah R Hadi, Nils Haep, Teklehaimanot Gereziher Haile, Erin B Hamilton, Ikramul Hasan, Hamidreza Hasani, Sara Hassanzadeh, Johannes Haubold, Simon I Hay, Khezar Hayat, Olayinka Stephen Ilesanmi, Sumant Inamdar, Chidozie C D Iwu, Assefa N Iyasu, Umesh Jayarajah, Shubha Jayaram, Mohammad Jokar, Nabi Jomehzadeh, Abel Joseph, Nitin Joseph, Charity Ehimwenma Joshua, Ali Kabir, Himal Kandel, Joonas H. Kauppila, Phillip M. Kemp Bohan, Himanshu Khajuria, Maseer Khan, Haitham Khatatbeh, Min Seo Kim, Adnan Kısa, Farzad Kompani, Hamid Reza Koohestani, Rakesh Kumar, Thao T. Le, Munjae Lee, Seung Won Lee, Ming‐Chieh Li, Stephen S Lim, Chun‐Han Lo, Raimundas Lunevičius, Kashish Malhotra, Andrea Maugeri, Rishi P Mediratta
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.