Boston – Socioeconomic status and where you live may impact your risk of developing acute appendicitis, according a new study. Led by researchers at Boston Medical Center, the study data showed that appendicitis was not evenly or randomly distributed across a large geographic region. In fact, there were clusters of high and low incidences in the area studied. Published in JAMA Surgery, the results indicate the need to further investigate whether there are specific risk factors for the development of appendicitis, which would help surgeons and researchers learn more about the causes of the disease and potentially point to strategies to reduce the risk of appendicitis.

Both acute and perforated appendicitis are serious conditions that require timely medical attention. There are approximately 250,000 cases of appendicitis in the US every year. With the exception of age and sex, data about the incidence of appendicitis has not indicated that there are other risk factors for getting the condition. Some previous studies have shown that lower socioeconomic status was associated with higher rates of perforated appendicitis, which was thought to be related to a lack of access to health care.

“Our study aimed to explore how socioeconomic status impacts the rates of both acute and perforated appendicitis cases across a single geographic area,” said Frederick Thurston Drake, MD, MPH from the department of surgery at Boston Medical Center and the study’s corresponding author.

This retrospective study utilized data from the Washington State Comprehensive Hospital Abstract Reporting System, which captures all inpatient hospitalization data, and the 2010 Census. The study included all patients who were diagnosed with acute appendicitis or perforated appendicitis who were discharged from the hospital in Washington between 2008 and 2012.

During the study’s five-year period, there were 35,370 patients with acute appendicitis, including 9,790 cases of perforated appendicitis. The incidence was higher in males than females, and the highest in males between the ages of 10 and 19 years old. The data also showed that appendicitis was not evenly or randomly distributed across a large population, but that neighborhoods were clustered into areas where the incidence was high and where incidence was low. The areas with lower incidence tended to be wealthier with higher levels of college education and other measures of socioeconomic status. In neighborhood clusters with a high incidence of appendicitis, there were lower levels of college education and lower median incomes.

“Given that appendicitis is the number one reason for urgent general surgery in the United States, it is critical for us to better understand how, where and why these cases emerge in different patterns across large geographic areas,” said Drake, who is also the Laszlo N. Tauber Assistant Professor of Surgery at Boston University School of Medicine. “Exploring the incidence of appendicitis using a novel set of questions and observations could reveal clues into how this disease impacts people at both the individual and community levels.”

Future research needs to be conducted to validate these results in other geographic areas, said the study authors. If similar associations with socioeconomic status are seen in other populations or locations, researchers will then be on track to determine why these associations are present, which may lead to improvements in the care of patients with appendicitis.

Sabrina E. Sanchez, MD, MPH. also from the department of surgery at Boston Medical Center and Boston University School of Medicine, served as co-author of this study.

About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $97 million in sponsored research funding in fiscal year 2018. It is the 15th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet – 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit

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