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Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem?

Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem? NwomehB.C., ChisolmD.J., CanianoD.A. & KelleherK.J. (2006) Pediatrics, 117, 870-875. Objective Significant racial, ethnic and socio-economic disparities have been observed in the rates of perforated appendicitis among children, by using large administrative databases. This study evaluated whether these factors had an impact on the care of patients with appendicitis at a major children's hospital in the USA with a well-established, comprehensive and primary referral system. Methods A retrospective analysis was performed for all children between the ages of 2 and 20 years old who were treated for appendicitis between 1 January 2001 and 31 December 2003. Demographic variables included patient age, gender, race, insurance status, parental educational status and income level. Coding data were used to identify patients with perforated appendicitis. The use of radiologic imaging was also analysed. Results During the 3-year period, 788 patients were treated for appendicitis. The racial distribution (white: 81%; black: 12%; other: 7%) was consistent with the demographic composition of the local population. The overall perforation rate was 25%, and the rate was significantly greater in the age group of <6 years, compared with older children. However, there were no significant differences in the perforation rate with respect to race, insurance status, educational level, or income status. Rates of radiologic imaging use were similar among all racial and socio-economic groups. Conclusions Although racial and socio-economic disparities in the rates of perforated appendicitis among children have been reported, we found no significant evidence for such inequality at our institution. This may reflect improved access, early diagnosis and referral by primary care physicians in the community. Pooled national and multiple-state administrative databases have been used to highlight persistent disparities in health care. This study illustrates how single-institution data sources can be used to test a local hypothesis generated by national data, with surprisingly different results.

Published 20 June 2006 in Child Care Health Dev, 32(4): 503-4.
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