Trends in the global burden of appendicitis in children at global, regional, and national levels: An analysis using GBD 2021 data.

Abstract

Background: Acute appendicitis is one of the most common general surgical diseases in children. The high misdiagnosis rate and high complication rate of appendicitis in the pediatric population have led to a more serious incidence of appendicitis in children. Therefore, for pediatric appendicitis, early accurate diagnosis and timely intervention are of vital importance.

Methods: This cross-sectional study used data from the Global Burden of Disease (GBD) 2021 database to analyze the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year rate (ASDR) of appendicitis in children aged 0 to 14 years from 1990 to 2021. We calculated the average estimated annual percentage change (EAPC) using linear regression and analyzed the trends using the joinpoint analysis. The analysis was stratified by region, country, and Socioeconomic Development Index (SDI). We examined the associations of the EAPC with SDI and baseline rates.

Results: A total of 63,401,760 children were included. In 2021, the global number of incident cases of pediatric appendicitis was estimated at 2,193,019.79 (95% UI, 1,405,218.04 to 3,186,592.24), corresponding to a 24% increase (95% UI, 22% to 27%) from 1990. Concurrently, the number of deaths was 2,319.37 (95% UI, 1,728.04 to 2,876.17), reflecting a 68% decline (95% UI, 76% to 54%) over the same period. From 1990 to 2021, the growth of ASIR was not significant globally [EAPC = 0.05 (-0.08 to 0.17), p > 0.05], but there was a significant increase from 2001 to 2004 [APC = 3.28 (2.74 to 3.84), p < 0.05]. Additionally, ASMR [EAPC = -3.99 (-4.11 to -3.87), p < 0.05] and ASDR [EAPC = -3.77 (-3.84 to -3.69), p < 0.05] showed significant decreases. ASIR showed an increasing trend in the High-middle SDI region [EAPC = 1.05 (0.85 to 1.25), p < 0.05], while it decreased in the Low SDI region [EAPC = -0.45 (-0.53 to -0.37), p < 0.05]. ASMR showed the most significant decreasing trend in the High-middle SDI region [EAPC = -5.74 (-6.01 to -5.46), p < 0.05]. ASDR showed the most significant decreasing trend in the Middle SDI region [EAPC = -4.49 (-4.77 to -4.22), p < 0.05]. In 2021, across 21 regions and 204 countries worldwide, ASIR continued to increase along with the rise in SDI. However, ASMR and ASDR continuously decreased as SDI increased. Over the 32-year period, a positive correlation was observed between the EAPC of ASIR and SDI (Pearson correlation coefficient r = 0.27, p < 0.05), while a negative correlation was found between the EAPC of ASMR and SDI (Pearson correlation coefficient r = -0.30, p < 0.05).

Conclusions: This study reveals that although the global number of incident cases of pediatric appendicitis has increased, both the ASMR and ASDR demonstrate significant declining trends. However, substantial disparities persist due to the uneven distribution of healthcare resources. Regions with high SDI should prioritize preventive measures to control the rising incidence, while low SDI regions must invest in healthcare resources to improve diagnosis, treatment, and reduce mortality rates. Countries can adapt targeted strategies implemented by nations that have successfully achieved substantial reductions in disease burden.