ArticleLancet regional health. Americas2026
Epidemiology of appendicitis in Ecuador, 2004-2024: a national time-series analysis of incidence, trends, geographic variation, and case-fatality rates.
Article in Lancet regional health. Americas, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Appendicitis is a common surgical emergency and a leading cause of gastrointestinal hospital admission in Ecuador. However, its long-term national patterns have not been comprehensively characterized. We aimed to describe appendicitis-related hospital discharge rates, temporal and geographic variation, and in-hospital case-fatality in Ecuador during 2004-2024. Methods: We conducted a nationwide descriptive ecological study using publicly available, anonymized hospital discharge records from the Ecuadorian National Institute of Statistics and Censuses. The unit of temporal and geographic analysis was the canton-year. Discharges with a primary ICD-10 diagnosis of K35-K37 were included. Annual population denominators were used to calculate crude and age- and sex-specific hospital discharge rates per 100,000 population. In-hospital case-fatality was calculated as deaths among appendicitis-related discharges. Comparisons were descriptive and unadjusted. Findings: We identified 717,639 appendicitis-related discharges, including 378,080 (52.7%) among males and 339,559 (47.3%) among females, and 1179 in-hospital deaths (case-fatality 0.164%). Recorded ethnicity was Mestizo in 602,817 (84.0%), Indigenous in 12,918 (1.8%), other in 9329 (1.3%), White in 3588 (0.5%), and Afro-Ecuadorian in 2153 (0.3%); 23,682 (3.3%) were recorded in additional categories, including Montubio, and 63,152 (8.8%) were unknown or unrecorded. Discharge rates increased until 2018-19, declined in 2020, and only partially recovered by 2024. Rates were highest mainly among adolescents and young adults, and crude case-fatality varied across health-system characteristics. Interpretation: Appendicitis represents a substantial surgical burden in Ecuador. The observed temporal, geographic, and health-system variation supports strengthening timely diagnosis, referral pathways, and equitable surgical access. Findings are ecological and should not be interpreted causally. Funding: No funding.
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