Appendicitis burden, trends, and inequalities in Europe, 1990-2019: a population-based study.

Background: Appendicitis imposes a substantial healthcare burden globally, yet comprehensive insights into its disease burden in Europe remain limited. This study assesses regional trends, disparities and high-burden countries for appendicitis in Europe. Methods: Data on appendicitis-related incidence, mortality and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease 2019 study. Joinpoint regression analyzed temporal trends, while health inequality and quadrant analyses identified socio-demographic disparities and priority countries. Results: In 2019, Europe's age-standardized incidence rate (ASIR) for appendicitis was 266.47 per 100,000, exceeding the global average (229.86 per 100,000). However, Europe's age-standardized mortality rate and age-standardized DALY rate were lower than the global averages. From 1990 to 2019, the average annual percentage change (AAPC) for the ASIR was 0.50%, whereas the AAPCs for the age-standardized mortality rate and age-standardized DALY rate were -3.02% and -2.20%, respectively. Finland was the sole exception, showing a reduced ASIR (AAPC: -0.20%). Health inequality analysis revealed that the burden of DALYs disproportionately affected less developed European nations. However, there was a notable improvement over the past three decades. The slope index of inequality decreased from -7.32 DALYs per 100,000 in 1990 to -1.02 DALYs per 100,000 in 2019, and the relative concentration index fell from -11.04 to -2.58 during the same period. Among the 43 countries, Bulgaria and Austria had the highest 2019 DALY burdens. Conclusions: Appendicitis persists as a critical public health challenge in Europe, necessitating targeted resource allocation and policy interventions in high-burden countries to address persistent health inequalities.