Epidemiology of appendicitis and appendectomy for the low-income population in Taiwan, 2003–2011

Abstract

BackgroundAlthough numerous epidemiological studies on appendicitis have been conducted worldwide, only a few studies have paid attention to the effect of socioeconomic status on appendicitis, particularly studies focusing on the low-income population (LIP).MethodsWe analyzed the epidemiological features of appendicitis in Taiwan using data from the National Health Insurance Research Database from 2003 to 2011. All cases diagnosed as appendicitis were enrolled.ResultsBetween 2003 and 2011, 2,916 patients from the LIP and 209,206 patients from the normal population (NP) were diagnosed with appendicitis. Our finding revealed that the ratios of comorbidities, complicated appendicitis, and readmissions in LIP patients were slightly higher than those of NP patients. LIP patients were more likely to live in suburban and rural areas, and hence a higher proportion of them were hospitalized in a district or regional hospital compared with NP patients. The crucially finding was that the overall incidence ratios of appendicitis, acute appendicitis, and perforated appendicitis in the LIP were substantially higher than those in the NP (36.25%, 35.33%, and 37.28%, respectively). The mean LOS in LIP patients was longer than that of NP patients. The overall case-fatality ratio of appendectomy in the LIP was higher when compared with the NP (0.41% versus 0.12%, p < 0.05). We also observed that appendicitis was occurred frequently in male patients, with a higher incidence for those aged 15–29 years in both the LIP and NP. The incidences of incidental appendectomy showed a decreasing trend in both the LIP and NP. Finally, a valuable discovery was that the total hospital cost was comparable between the laparoscopic appendectomy (LA) and open appendectomy (OA) (1,178 ± 13 USD versus 1,191 ± 19 USD, p < 0.05) in LIP patients because they saved more hospitalization costs than NP patients when the previous one chose the LA.ConclusionThis study confirmed that a lower socioeconomic status has significantly negative impact on the occurrence and treatment of appendicitis and appendectomy. In terms of hospital costs and LOS, LIP patients benefit more from the LA approach than they do from the OA approach in the treatment of appendicitis.

Acute appendicitis may no longer be a predominant disease of the young population

“…In general hospital length of stay did not exceed 3 days, with the vast majority not requiring hospitalization in the ICU (Table 1). This is also consistent with current literature demonstrating low hospitalization length of stay mainly for low-grade appendicitis [5][6][7][8][9][10].…”

“…Acute appendicitis affects around 10% of the population and is, therefore, one of the most prevalent surgical emergencies [4][5][6][7][8]. Many authors characterize appendicitis as a predominant disease of young people; however, the cases operated by our group over the last two years have led us to advance the hypothesis that a shift of this paradigm could be occurring.…”

Epidemiological aspects of patients underwent appendectomy in Birjand, Iran, from May 2017 to 2019

“…The annual incidence of appendicitis in the rural population of Maharashtra state, India, was 30.18, 40.17 and 30.85 per 10,000 population in three consecutive studied years, respectively, which was significantly higher than that in this study (13). Lin et al (2015) analyzed epidemiological features of appendicitis in Taiwan from 2003 to 2011. They reported that the overall incidence rate of appendicitis was 13.95 per 10,000 population per year in this country which was also higher than that in the present study (14).…”

“…Lin et al (2015) analyzed epidemiological features of appendicitis in Taiwan from 2003 to 2011. They reported that the overall incidence rate of appendicitis was 13.95 per 10,000 population per year in this country which was also higher than that in the present study (14). Based on a metaanalysis carried out by Ferris et al (2017) throughout the 21 st century, the incidence rate of appendicitis in North America stabilized and was estimated 10 per 10000 people/year (11).…”

Socio-demographic Characteristics of Acute Appendicitis Patients attended at a Tertiary Care Teaching Hospital in Bangladesh

“…Acute appendicitis is a common surgical emergency especially in children 1 . Current studies have showed that the incidence of acute appendicitis has declined in western countries 2 .…”