Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access

Abstract

BACKGROUND: The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes. METHODS: We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. RESULTS: Rupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% - 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors. CONCLUSION: The racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable outcome for this condition as well.

Quantifying the disparity in outcome between urban and rural patients with acute appendicitis in South Africa

“…[8,9] Higher rupture rates have been reported in ethnic minority children, younger children, children with addresses from socioeconomically poorer ZIP codes, children who lack private insurance and children referred from somewhere other than a dedicated emergency department. [10] In our study cohorts, rural patients fared significantly worse than their urban counterparts. Both groups were black, thus eliminating issues of ethnicity or cultural practices as an explanation for disparate outcomes.…”

Race and Acute Abdominal Pain in a Pediatric Emergency Department

“…Multiple authors have reported that rates of rupture vary across racial lines, with minorities generally having higher rates. 2,[8][9][10] These differences have not been explained by differences in insurance or socioeconomic status. 11 However, others have shown that racial differences in ruptured appendicitis disappeared after adjusting for access to care.…”

Predictors of Perforated Appendix among Children

“…Similar to the Guagliardo et al [6], we found no evidence of an increase in appendiceal rupture with Hispanic patients who had Public Aid as their primary insurance (Correlation: 0.13; Odds Ratio: 0.5-1.1g; P value: 0.5853e). However, studies by Jablonski and Guagliardo [7] and Levas et al [8] indicate that there exists such an association which can be attributed to limited English proficiency, Hispanic ethnicity, lacking private insurance, referred from somewhere other than the ED, discharged from a teaching hospital, from poorer ZIP codes and discharged from a high-volume hospital. As suggested in a study Levas et al [8], equal access to care is the key to preventing any disparities in pediatric appendicitis outcome [9].…”

“…Identifying variables that can predict ruptured appendix remains crucial to ensure that the patient receives optimal care promptly. Many large databases, multicenter reviews have shown disparities in acute appendicitis and ruptured appendix based on variables such as ethnicity and socioeconomic status [6,7]. We attempted to study these variables, in addition to many others, in cases of appendicitis found in an urban community hospital setting.…”