Association Between Neighborhood-Level Social Determinants of Health and Access to Pediatric Appendicitis Care

Abstract

IMPORTANCE Presenting with complicated appendicitis, which is associated with higher rates of complications and readmissions compared with simple appendicitis, may indicate delayed access to care. Although both patient-level and neighborhood-level social determinants of health are associated with access to care, little is known about the association between neighborhood factors and access to acute pediatric surgical care. OBJECTIVE To examine the association between neighborhood factors and the odds of presenting with complicated appendicitis and unplanned postdischarge health care use. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of patients aged 18 years or younger diagnosed with appendicitis was conducted. Discharge data from October 1, 2015, to September 30, 2018, were obtained from the Pediatric Health Information System Database and linked to the Child Opportunity Index (COI) 2.0 Database. Data analysis was conducted from January 1 through July 1, 2021. EXPOSURES The COI, a composite score of zip code neighborhood opportunity level information, divided into quintiles ranging from very low to very high opportunity. MAIN OUTCOMES AND MEASURES Based on COI level, the main outcome was the odds of presenting with complicated appendicitis, which was defined using the Agency for Healthcare Research and Quality-specified International Statistical Classification of Diseases, 10th Edition, Clinical Modification codes. The secondary outcome was the odds of unplanned postdischarge health care use (emergency department visits and/or readmissions) for patients with simple and with complicated appendicitis.RESULTS A total of 67 489 patients (mean [SD] age, 10.5 [3.9] years) had appendicitis, with 31 223 cases (46.3%) being complicated. A total of 1699 patients (2.5%) were Asian, 24 234 (35.9%) were Hispanic, 4447 (6.6%) were non-Hispanic Black, and 29 234 (43.3%) were non-Hispanic White; 40 549 patients (60.1%) were male; and 32 343 (47.9%) were publicly insured. Patients living in very low-COI neighborhoods had 28% higher odds of presenting with complicated appendicitis (odds ratio, 1.28; 95% CI, 1.20-1.35) compared with those in very high-COI neighborhoods. There was no significant association between COI level and unplanned postdischarge health care use (very high COI, 20.8%; very low COI, 19.1%).

Delayed diagnosis of serious paediatric conditions in 13 regional emergency departments

“…Similarly, different patterns of testing may exist for publicly insured children compared with privately insured children. The presence of such biases is supported by prior work demonstrating similar, troubling disparities across race/ethnicity, socioeconomic status, and language in access, diagnosis and management 8 9 11–19…”

Association of Satisfaction With Treatment Decision and Failure of Nonoperative Management of Appendicitis in Children

“…There may also be cultural differences in interpreting the risk to benefit ratios because surgery was more likely chosen by those whose primary language was English. 4 In addition, children presenting from low Child Opportunity Index neighborhoods may have increased odds of presenting with complicated appendicitis, 7 which may have excluded nonoperative management candidates.…”

Racialized economic segregation and potentially preventable hospitalizations among Medicaid/CHIP‐enrolled children

“…Children who live in different neighborhoods across the United States face different conditions of daily life and have different access to the resources they need to thrive, including health care 1 . As the source of health insurance coverage for over 40 million children, particularly for children of color and those living in families experiencing poverty, Medicaid and the Children's Health Insurance Program (CHIP) (hereafter referred to as Medicaid) shape health outcomes and health care equity among children 2–4 .…”