Dramatic Decline of Acute Appendicitis in Greece over 30 Years: Index of Improvement of Socioeconomic Conditions or Diagnostic Aids?

Abstract

Background and Aims: There are several reports showing a continuing fall in the incidence of acute appendicitis in the western countries. Our aim was to study the trend of the incidence of acute appendicitis in the Greek population over 30 years. Methods: We analyzed the data referring to the years 1970–1999 on the incidence and mortality of acute appendicitis for the entire Greek population. Data were retrieved from the Annual Bulletin for the Social Welfare and Health Statistics of the National Statistics Service of Greece. In this database, acute appendicitis was a hospital discharge diagnosis. Results: Over the study period, there was a 75% decrease of the age-standardized incidence of acute appendicitis from 652/100,000 to 164/100,000. The median female-to-male ratio of hospitalized patients for appendicitis of the study period (1970–1999) fell progressively from 1.27 in the year 1970 to 0.93 in the year 1999. The case fatality rates remained constant, ranging below 0.09 deaths per 100 appendicitis cases. Conclusion: There is a significant decline of the incidence of acute appendicitis in the Greek population over the years 1970–1999. This time trend is probably related to the improvement of the socioeconomic conditions over the same period and not to the introduction of new diagnostic aids.

Epidemiology of Appendectomy and Appendicitis in the Valencian Community (Spain), 1998–2007

“…The incidence of appendicitis and appendectomy is lower than in other studies [6,11]. However, we have not found any other population-based studies in Spain in such a recent study period as ours.…”

“…The incidence of acute appendicitis declined in Western countries between the 1930s and the early 1990s, but most published studies have covered periods only up to around 1990 [1,2,3,4,5,6,7,8,9,10,11]. The reason for this decline is not clear.…”

Association between appendicectomy in females and subsequent pregnancy rate: a cohort study

“…An early and increased conception rate has been found in women with short education and low socioeconomic status (14). There is some evidence that appendicitis is also associated with a low socioeconomic status (15,16). This, however, does not explain all the observed apparent increase in subsequent pregnancies after appendicectomy in this study, because some females who had an appendicectomy did not have appendicitis.…”

Demographic and Epidemiologic Features of Acute Appendicitis

“…It is believed that the spread of the western-type diet in African and Asian societies today is responsible for the increase in the number of AA cases observed. However, we found in a previous study that short-term dietary changes had no effect on an increase in AA incidence (Papadopoulos et al, 2008). Studies conducted on the effects of fasting seem to support this conclusion.…”

“…A recent study from Spain found a decrease in appendicitis in the last 10 years (Andreu-Ballester et al,2009). A study from Greece evaluating the last 30 years found the age-standardized appendicitis rate to fall 75% from 652/100.000 to 164/100.000 (Papadopoulos et al,2008). Both countries eat a Mediterranean diet rich in fiber but the decrease in Spain may be due to improved hygienic conditions with socioeconomic development.…”