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

Abstract

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. 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. 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. 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. 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.