Global, regional, and national burden of appendicitis among children and adolescents from 1990 to 2021 and projection to 2040: a cross-sectional study.

BACKGROUND AND IMPORTANCE: Appendicitis is a common surgical emergency in children and adolescents, yet its global epidemiological trends and burden remain understudied. This study aims to analyze the global burden of appendicitis in children aged 0-19 years from 1990 to 2021. METHODS: We extracted data from the Global Burden of Disease 2021 study to analyze the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) attributable to appendicitis. Age-standardized rates and trends were stratified by sex, age group, region, and Socio-demographic Index (SDI). RESULTS: In 2021, there were 4.53 million new cases of appendicitis and 360 249 DALYs among children and adolescents globally. The highest age-standardized incidence rate (270.38 [95% uncertainty interval {UI}, 180.93-386.54]) was observed in high-SDI regions, while the highest mortality rate (0.23 [95% UI, 0.14-0.35]) occurred in low-SDI regions. From 1990 to 2021, global age-standardized incidence and prevalence rates decreased slightly, while mortality and DALYs declined substantially. However, the age-standardized incidence and prevalence rates began increasing after 2015 and are projected to rise by over 21% by 2040. Frontier analysis highlighted strong performance in Somalia and Niger among low-SDI countries, whereas the United States Virgin Islands, a high-SDI region, exhibited considerable potential for improvement. CONCLUSIONS: The burden of appendicitis among children and adolescents remains significant, with pronounced inequalities across SDI levels. Addressing these inequities requires targeted interventions, such as improving surgical infrastructure in low-SDI regions and optimizing resource utilization in high-SDI regions. These findings provide a foundation for evidence-based policies to ensure equitable care for this vulnerable population.