Disparities/Minority Health

More minority and Medicaid-insured children experience perforated appendicitis than other children

In one-third of children suffering from appendicitis, the appendix perforates (ruptures) before surgery, resulting in more complications and longer hospital stays. Usually caused by delayed diagnosis and treatment, perforated appendicitis disproportionally affects both minority and Medicaid-insured children, irrespective of hospital volume of appendicitis cases, according to a recent study supported by the Agency for Healthcare Research and Quality (T32 HS00063).

To reduce these disparities, efforts should focus on the causes of delayed diagnosis and treatment of appendicitis in minority and Medicaid-insured children, suggests Douglas S. Smink, M.D., M.P.H., of Children's Hospital Boston. Dr. Smink and his colleagues analyzed the Kids' Inpatient Database (KID)—AHRQ's database of pediatric hospital discharges from 22 States in 1997—to determine patient and hospital characteristics predictive of perforated appendicitis among children admitted for acute appendicitis. The appendix had ruptured in one-third of the 33,183 children hospitalized for acute appendicitis.

After accounting for several factors affecting perforation, black and Hispanic children were 24 percent and 19 percent more likely, respectively, to have perforated appendicitis than white children. Perforation was also 30 percent more likely among Medicaid-insured than privately insured children. Although high hospital volume is usually associated with better patient outcomes, annual hospital volume of appendicitis cases was not significantly associated with perforation in this study.

See "Effects of race, insurance status, and hospital volume on perforated appendicitis in children," by Dr. Smink, Steven J. Fishman, M.D., Ken Kleinman, Sc.D., and Jonathan A. Finkelstein, M.D., M.P.H., in the April 2005 Pediatrics 115(4), pp. 920-925.

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