Objective  To analyze the disease burden of appendicitis in China from 1990 to 2021 and to predict the future trends.

Methods  The incidence, mortality, disability-adjusted life-years (DALY) and corresponding age-standardized rates of appendicitis in China from 1990 to 2021 were extracted from the 2021 Global Burden of Disease Study database. The annual percentage change and average annual percentage change (AAPC) were calculated using Joinpoint software to analyze the changing trend of the disease burden of appendicitis in China from 1990 to 2021. A Bayesian age-period-cohort (BAPC) model was constructed to predict the changes in the disease burden of appendicitis in China from 2022 to 2040.

Results  The age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of appendicitis in China in 2021 were 311.67/100 000, 0.09/100 000, and 5.81/ per 100 000 person years, respectively. From 1990 to 2021, the ASIR [AAPC=0.75%, 95%CI (0.71%, 0.80%)] for appendicitis in China showed an increasing trend, while the ASMR [AAPC=-5.32%, 95%CI (-5.38%, -5.26%)] and ASDR [AAPC=-3.51%, 95%CI (-3.55%, -3.48%)] both showed a decreasing trend. Women had a higher incidence rate than men, but lower mortality and DALY rates. The incidence rate of appendicitis in China initially increased and then decreased with age, with the peak age of onset always between 15~24 years. Deaths were primarily among the elderly, with the peak age of death being over 85 years. The peak age of the DALY rate of appendicitis in China was concentrated between the ages of 90 and 94. A BAPC model predicted that the ASIR of appendicitis in China would increase from 2022 to 2040, while the ASMR and ASDR showed a decrease trend.

Conclusion  From 1990 to 2021, the ASIR of appendicitis in China increased, while the ASMR and ASDR decreased, and the overall disease burden showed a slow decline in the future. Currently, efforts should be made to strengthen prevention and treatment efforts among the elderly, vigorously carry out scientific education, and promote healthy lifestyles and dietary patterns to further reduce the disease burden of  appendicitis.

1.Kumar SS, Collings AT, Lamm R, et al. SAGES guideline for the diagnosis and treatment of appendicitis[J]. Surg Endosc, 2024, 38(6): 2974-2994. DOI: 10.1007/s00464-024-10813-y.

2.He R, Lai J, Jiang O, et al. The incidence and temporal trend of appendicitis in children: an analysis from the Global Burden of Disease Study 2021[J]. J Gastrointest Surg, 2024, 29(2):101935. DOI: 10.1016/j.gassur.2024.101935.

3.Vaos G, Zavras N. Update on the diagnosis and treatment of acute appendicitis[J]. J Clin Med, 2024, 13(23): 7343. DOI: 10.3390/jcm13237343.

4.GBD 2021 Appendicitis Collaborator Group. 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[J]. Lancet Gastroenterol Hepatol, 2024, 9(9): 825-858. DOI: 10.1016/S2468-1253(24)00157-2.

5.刘宁, 张红岩, 杨绍萱, 等. 基于年龄-时期-队列模型的中国阑尾炎疾病负担分析[J]. 国际流行病学传染病学杂志, 2024, 51(5): 294-299. [Liu N, Zhang HY, Yang SX, et al. Analysis of national burden of appendicitis in China based on the age-period-cohort model[J]. International Journal of Epidemiology and Infectious Disease, 2024, 51(5): 294-299.] DOI: 10.3760/cma.j.cn331340-20240511-00093.

6.Murray C. The Global Burden of Disease Study at 30 years[J]. Nat Med, 2022, 28(10): 2019-2026. DOI: 10.1038/s41591-022-01990-1.

7.李辉章, 杜灵彬. Joinpoint回归模型在肿瘤流行病学时间趋势分析中的应用[J]. 中华预防医学杂志, 2020, 54(8): 908-912. [Li HZ, Du LB. Application of Joinpoint regression model in cancer epidemiological time trend analysis[J]. Chinese Journal of Preventive Medicine, 2020, 54(8): 908-912.] DOI: 10.3760/cma.j.cn112150-20200616-00889.

8.Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for Joinpoint regression with applications to cancer rates[J]. Stat Med, 2000, 19(3): 335-351. DOI: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z.

9.郑荣寿, 陈万青. 基于贝叶斯方法的年龄-时期-队列预测模型的介绍[J]. 中华预防医学杂志, 2012, 46(7): 648-650. [Zheng RS, Chen WQ. Introduction to age-period-cohort prediction model based on Bayesian method[J]. Chinese Journal of Preventive Medicine, 2012, 46(7): 648-650.] DOI: 10.3760/cma.j.issn.0253-9624.2012.07.016.

10.Li HM, Yeh LR, Huang YK, et al. Familial risk of appendicitis: a nationwide population study[J]. J Pediatr, 2018, 203(12): 330-335. DOI: 10.1016/j.jpeds.2018.07.071.

11.Sadr AO, Andren-Sandberg A, Larsson H. Genetic and environmental influences on the risk of acute appendicitis in twins[J]. Br J Surg, 2009, 96(11): 1336-1340. DOI: 10.1002/bjs.6736.

12.Arnbjornsson E. Acute appendicitis and dietary fiber[J]. Arch Surg, 1983, 118(7): 868-870. DOI: 10.1001/archsurg.1983. 01390070076015.

13.Adamidis D, Roma-Giannikou E, Karamolegou K, et al. Fiber intake and childhood appendicitis[J]. Int J Food Sci Nutr, 2000, 51(3): 153-157. DOI: 10.1080/09637480050029647.

14.Morris J, Barker DJ, Nelson M. Diet, infection, and acute appendicitis in Britain and Ireland[J]. J Epidemiol Community Health, 1987, 41(1): 44-49. DOI: 10.1136/jech.41.1.44.

15.Oldmeadow C, Wood I, Mengersen K, et al. Investigation of the relationship between smoking and appendicitis in Australian twins[J]. Ann Epidemiol, 2008, 18(8): 631-636. DOI: 10.1016/j.annepidem.2008.04.004.

16.Kaplan GG, Dixon E, Panaccione R, et al. Effect of ambient air pollution on the incidence of appendicitis[J]. CMAJ, 2009, 181(9): 591-597. DOI: 10.1503/cmaj.082068.

17.Kaplan GG, Tanyingoh D, Dixon E, et al. Ambient ozone concentrations and the risk of perforated and nonperforated appendicitis: a multicity case-crossover study[J]. Environ Health Perspect, 2013, 121(8): 939-943. DOI: 10.1289/ehp.1206085.

18.Wei PL, Chen CS, Keller JJ, et al. Monthly variation in acute appendicitis incidence: a 10-year nationwide population-based study[J]. J Surg Res, 2012, 178(2): 670-676. DOI: 10.1016/j.jss.2012.06.034.

19.Ahmed W, Akhtar MS, Khan S. Seasonal variation of acute appendicitis[J]. Pak J Med Sci, 2018, 34(3): 564-567. DOI: 10.12669/pjms.343.14793.

20.Frasca DJ, Jarrio CE, Perdue J. Evaluation of acute pelvic pain in women[J]. Am Fam Physician, 2023, 108(2): 175-180. https://pubmed.ncbi.nlm.nih.gov/37590858/

21.Andersson RE, Lambe M. Incidence of appendicitis during pregnancy[J]. Int J Epidemiol, 2001, 30(6): 1281-1285. DOI: 10.1093/ije/30.6.1281.

22.王峰, 崔强强, 游志恒. 腹腔镜在小儿复杂肝下阑尾炎中的诊治研究[J]. 西部医学, 2024, 36(11): 1666-1670. [Wang F, Cui QQ, You ZH. Application research of laparoscopy in diagnosis and treatment of complex subhepatic appendicitis in children[J]. Medical Journal of West China, 2024, 36(11): 1666-1670.] DOI: 10.3969/j.issn.1672-3511.2024.11.020.

23.毕颖, 李前龙, 杨正英, 等. 留置阑尾支架在内镜逆行性阑尾炎治疗术治疗急性化脓性阑尾炎中的疗效分析[J]. 西部医学, 2025, 37(4): 584-587. [Bi Y, Li QL, Yang ZY, et al. Efficacy of appendiceal stent indwelling in endoscopic retrograde appendicitis treatment for acute suppurative appendicitis[J]. Medical Journal of West China, 2025, 37(4):584-587.] DOI: 10.3969/j.issn.1672-3511.2025.04.021.