{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:20:47Z","timestamp":1789827647820,"version":"4.0.1"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Appendicitis remains a common surgical emergency with potentially fatal complications. Long\u2010term trends in mortality disparities are not well characterized. We analyzed demographic and regional disparities in appendicitis\u2010related mortality in the United States from 1999 to 2020 using CDC WONDER data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of death\u2010certificate data for individuals aged \u2265\u00a025\u00a0years, identifying appendicitis\u2010related deaths (ICD\u201010 K35\u2013K37). Age\u2010adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 U.S. standard. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 1999 to 2020, 15,243 appendicitis\u2010related deaths occurred (6643 females and 8600 males). Overall AAMR declined from 0.38 to 0.32 per 100,000 (AAPC\u00a0\u20131.38% and 95% CI\u00a0\u20133.10 to 0.36). A significant decrease occurred from 1999 to 2018 (APC\u20132.81% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001), followed by a nonsignificant rise. Males exhibited a consistent decline (AAPC \u20132.88% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001), whereas females experienced an increase from 2016 to 2020 (APC +5.94% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). Black individuals had the highest AAMR (0.38) but a significant decline (AAPC \u20133.73% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) compared to Whites (AAPC \u20132.49% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) and Hispanics (AAPC \u20132.06% and\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). Nonmetropolitan areas had higher AAMR (0.34) than metropolitan areas (0.31). Vermont and New Mexico recorded the highest state\u2010level AAMRs; New Jersey and Louisiana had the lowest.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Appendicitis\u2010related mortality in the United States declined over two\u00a0decades; 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70023","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T03:57:58Z","timestamp":1753761478000},"page":"2399-2408","source":"Crossref","is-referenced-by-count":2,"title":["Trends and Disparities in Appendicitis\u2010Related Mortality Across U.S. Demographics and Regions: A 22\u2010Year CDC WONDER Database 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