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Appendicitis becomes 'a global disease,' with rising rates in developing world
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Data from a systematic review recently published in the Annals of Surgery highlight how appendicitis has evolved into a global disease since the turn of the century.
While the incidence of appendicitis has remained stable in most Western nations, limited data from the developing world suggest that appendicitis is rapidly increasing in newly industrialized nations.
Gilaad G. Kaplan
“We recently passed the 130th year anniversary of Dr. Reginald Fitz’s landmark publication that introduced the term ‘appendicitis’ into the medical vernacular,” Gilaad G. Kaplan, MD, MPH, FRCPC, associate professor at the University of Calgary in Alberta, Canada, told Healio Gastroenterology. “Since 1886 the incidence of appendicitis increased dramatically in the Western world. For unexplained reasons this incidence dropped significantly during the middle to late portions of the 20th century. In contrast, during the 20th century, appendicitis was almost unrecognized in developing countries, yet now, at the turn of the 21st century, newly industrialized countries have begun to report rapidly rising incidence.”
Kaplan and colleagues reviewed 120 population-based studies reporting on the incidence of appendicitis or appendectomy throughout the world, which were published through the middle of 2015.
They found that since the turn of the century, the pooled incidence in North America was 100 (95% CI, 91-110) per 100,000 person-years, and they estimated there were 378,614 cases in 2015. Further, the incidence ranged from 105 to 151 per 100,000 person-years in Eastern and Western Europe, respectively.
Notably, the incidence of appendectomy steadily declined in Western nations since 1990, with an annual percentage change of –1.54 (95% CI, –2.22 to –0.86). However, the incidence of appendicitis stabilized, with an annual percentage change of –0.36 (95% CI, –0.97 to 0.26).
Conversely, the researchers found a high incidence of appendicitis or appendectomy in newly industrialized countries across Asia, the Middle East and South America, with pooled incidences of 206 per 100,000 person-years in South Korea, 160 in Turkey and 202 in Chile, for example.
“The epidemiological patterns of appendicitis support the notion that appendicitis is driven by multifactorial environmental triggers associated with the industrialization of society,” and future research should explore this further, the investigators concluded.
Visual, dynamic data
Kaplan and colleagues also developed an interactive map to continue to report the global incidence of appendicitis as more data are collected. Kaplan emphasized the importance of this novel method for reporting dynamic data.
“Summarizing all this information in the main body of a manuscript is daunting in light of tight word and page limits,” he said. “Moreover, once a paper is published the information becomes frozen in time, without the opportunity to update as new information is published.”
The interactive map “allows the reader to click on individual countries and learn about the incidence of appendicitis for that country, [which] allows us to concisely visually summarize a large amount of data,” he added. “Also, the interactive map can be updated online, allowing for the presentation of dynamic changing data over time.”
Similarly, Kaplan and colleagues visually summarized their data in a “visual abstract,” which Annals of Surgery have been creating for certain research papers since last year. A recent study conducted by University of Michigan researchers, also published in Annals of Surgery, showed that the use of these “Twitter-friendly” graphics can almost triple the number of people who click the link in a tweet to read a full study.
“We’ve also modified our design in response to feedback, for instance adding P values so a Twitter user can see the statistical significance of the result,” Andrew Ibrahim, MD, a surgery resident and University of Michigan and creative director of Annals of Surgery who pioneered the use of visual abstracts, said in a press release. “Sometimes we’re trying to summarize five years’ worth of work in a single graphic, and we never claim it’s a substitute for reading the full article or even the text abstract. But it’s a way to help people decide if this is a paper they’d be interested in reading or not.” – by Adam Leitenberger
References:
Global appendicitis interactive map. https://people.ucalgary.ca/~ggkaplan/Append2016.html.
Ibrahim AM, et al. Ann Surg. 2017;doi:10.1097/SLA.0000000000002277.
Disclosures: The researchers report no relevant financial disclosures.
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