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

被引：83

作者：

Jablonski K.A. ^{[1
]}

Guagliardo M.F. ^{[2
,3
]}

机构：

[1] Biostatistics Center, George Washington University, Rockville, MD 20852

[2] Department of Prevention and Community Health, George Washington University, School of Public Health and Health Services, Washington, DC

[3] Center for Health Services and Community Research, Children's National Medical Center, Washington, DC 20010

来源：

Population Health Metrics | / 3卷 / 1期

关键词：

Appendicitis; Acute Appendicitis; African American Child; White Child; Negative Appendectomy;

D O I：

10.1186/1478-7954-3-4

中图分类号：

学科分类号：

摘要：

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. © 2005 Jablonski and Guagliardo; licensee BioMed Central Ltd.

引用

页数：9

共 46 条

[1]

Smedley B.D., Stith A.Y., Nelson A.R., Institute of Medicine (U.S.), Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care, (2002)

[2]

Healthy People 2010, (2000)

[3]

National Healthcare Disparities Report: Update on Current Status, (2002)

[4]

National Healthcare Disparities Report - July 2003 Draft, (2003)

[5]

Pearl R.H., Hale D.A., Molloy M., Schutt D.C., Jaques D.P., Pediatric appendectomy, J. Pediatr. Surg., 30, pp. 178-181, (1995)

[6]

To T., Guttmann A., Dick P., Inpatient and Day Surgery Use by Children in Ontario, (2001)

[7]

Pittman-Waller V.A., Myers J.G., Stewart R.M., Et al., Appendicitis: Why so complicated? Analysis of 5755 consecutive appendectomies, Am. Surg., 66, pp. 548-554, (2000)

[8]

Silen W., Cope Z., Cope's Early Diagnosis of the Acute Abdomen, (1987)

[9]

Guagliardo M.F., Teach S.J., Huang Z.J., Chamberlain J.M., Joseph J.G., Racial and ethnic disparities in pediatric appendicitis rupture rate, Acad. Emerg. Med., 10, pp. 1218-1227, (2003)

[10]

Ponsky T.A., Huang Z.J., Kittle K., Et al., Hospital- And patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children, JAMA, 292, pp. 1977-1982, (2004)

← 1 2 3 4 5 →