Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access
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BioMed Central
Open Access
Research
Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access Kathleen A Jablonski1 and Mark F Guagliardo*2,3 Address: 1The Biostatistics Center, The George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, Maryland 20852, USA, 2Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, Washington, DC, USA and 3Center for Health Services and Community Research, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA Email: Kathleen A Jablonski - [email protected]; Mark F Guagliardo* - [email protected] * Corresponding author
Published: 04 May 2005 Population Health Metrics 2005, 3:4
doi:10.1186/1478-7954-3-4
Received: 21 February 2005 Accepted: 04 May 2005
This article is available from: http://www.pophealthmetrics.com/content/3/1/4 © 2005 Jablonski and Guagliardo; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 nonrupture 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 Nation
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