OBJECTIVES:  To evaluate the association of demographic factors, clinical complications and surgical management of diverticulitis with its recurrence. METHODS:  We identified all adults (18+ years) who had acute diverticulitis (incident cases) during 01/01/2007 to 12/31/2011 from the Kaiser Permanente Southern California Health Plan. Prior to diagnosis of the incident event (index date), the patients were required to be a health plan member continuously enrolled for ≥ 12 months (baseline period) without evidence of diverticulitis. We defined recurrence as a patient meeting case definition ≥ 30 days after the index date. Through chart review, we captured the following complications during the incident presentation: abscess, intestinal obstruction, pneumoperitoneum, fistula, and peritonitis. Lastly, we identified patients who had colon surgeries within 30 days of the index event. A stratified (by sex) cox proportional model was specified with sociodemographics, Elixhauser comorbidity, clinical complications and surgical management to evaluate the hazard of diverticulitis recurrence. RESULTS:  We identified 33,442 incident cases: 58% female; 68% white. Mean age (mean ± SD) in females was 61 ± 14 years while in males it was 56 ± 15 years. During a mean (median) of 46 (49) months follow-up, 11,092 patients had a recurrence. In females, the hazard of recurrence increased with complication of abscess (Hazard ratio; (95% CI) 1.4; (1.2 to 1.7)) while surgery reduced the recurrence hazard (0.7; (0.6 to 0.8)). In males, the hazard of recurrence increased with presentation of pneumoperitoneum (1.3; (1.1 to 1.5)) and abscess (1.6; (1.3 to 1.9)) while it decreased with findings of intestinal obstruction (0.6; (0.4 to 0.9)) and with surgery (0.5; (0.4 to 0.7)). Recurrence hazard significantly increased with age in females while it significantly decreased with increasing age in males. CONCLUSIONS:  We identified significant heterogeneity in the hazard of diverticulitis recurrence by presenting complications and by age, between the sexes.