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探讨一种病因不明的常见疾病:1995-2009 年加利福尼亚州阑尾炎的流行病学和手术治疗趋势。

Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995-2009.

机构信息

Department of Surgery, Center for Surgical Systems and Public Health, University of California San Diego, 200 W. Arbor Drive, San Diego, CA 92103, USA.

出版信息

World J Surg. 2012 Dec;36(12):2787-94. doi: 10.1007/s00268-012-1749-z.

Abstract

BACKGROUND

The study was designed to examine the epidemiology of appendicitis and risk factors of perforation and appendectomy.

METHODS

Retrospective analysis of the California Office of Statewide Health Planning and Development Patient Discharge Data was performed from 1995 to 2009. Patients with appendicitis were identified by ICD-9 diagnosis code. Population statistics from the RAND Corporation were used to calculate incidence rates. Risk factors of perforation and appendectomy were also calculated.

RESULTS

A total of 608,116 patients with appendicitis (70% non-perforated) were included. The incidence increased at an average rate of 0.5 cases/100,000 population/year (p<0.001), with annual incidence peaking during the third quarter. Children age 10-14 had the highest rates of appendicitis (169.6 cases/100,000). The lifetime cumulative incidence rate is 9.0%. Appendicitis is most common in whites and Hispanics and less common in African Americans and Asians. Risks of perforation include Hispanic or Asian race, young or old age, and non-private insurance. The adjusted odds of appendectomy increased since 1995 in patients with non-perforated appendicitis (OR 1.5, 95% CI (1.3-1.7); p<0.001), but it decreased in patients with perforated appendicitis (OR 0.4, 95% CI (0.4-0.5); p<0.001).

CONCLUSIONS

This is the largest epidemiological study of appendicitis to our knowledge in recent years. Incidence has increased over time and is higher in the summer months. Whites and Hispanics have higher rates of appendicitis, but Hispanics and Asians and patients with non-private insurance, have higher odds of perforation. Surgical management of perforated appendicitis has decreased over time. It is unknown why the incidence has increased, displays seasonality, and varies by race.

摘要

背景

本研究旨在探讨阑尾炎的流行病学以及穿孔和阑尾切除术的危险因素。

方法

对 1995 年至 2009 年加利福尼亚州全州卫生规划和发展患者出院数据进行回顾性分析。通过 ICD-9 诊断代码识别阑尾炎患者。兰德公司的人口统计数据用于计算发病率。还计算了穿孔和阑尾切除术的危险因素。

结果

共纳入 608116 例阑尾炎患者(70%为非穿孔)。发病率以平均每年 0.5 例/10 万人/年的速度增加(p<0.001),发病率在第三季度达到峰值。10-14 岁的儿童阑尾炎发病率最高(169.6/10 万人)。终生累积发病率为 9.0%。阑尾炎在白人和西班牙裔中最常见,在非裔美国人和亚洲人中较少见。穿孔的风险包括西班牙裔或亚洲种族、年轻或老年以及非私人保险。1995 年以来,非穿孔性阑尾炎患者的阑尾切除术调整后比值比(OR)增加(OR 1.5,95%可信区间(1.3-1.7);p<0.001),但穿孔性阑尾炎患者的 OR 降低(OR 0.4,95%可信区间(0.4-0.5);p<0.001)。

结论

这是我们近年来了解到的关于阑尾炎的最大规模的流行病学研究。发病率随时间推移而增加,夏季更高。白人及西班牙裔的阑尾炎发病率较高,但西班牙裔和亚洲裔以及非私人保险患者的穿孔风险较高。穿孔性阑尾炎的手术治疗随时间推移而减少。发病率增加、具有季节性且因种族而异的原因尚不清楚。

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