Research

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

Kathleen A Jablonski¹ and Mark F Guagliardo^2,3

¹  The Biostatistics Center, The George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, Maryland 20852, USA

²  Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, Washington, DC, USA

³  Center for Health Services and Community Research, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA

author email corresponding author email

Population Health Metrics 2005, 3:4doi:10.1186/1478-7954-3-4

Published:	4 May 2005

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.