Appendicitis Perforation Rates Are A Misleading Indicator Of Health Care Access

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Academic Journal
Main Category: GastroIntestinal / Gastroenterology
Article Date: 16 Jan 2012 - 13:00 PST

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A study published in the January issue of the Archives of Surgery suggests that using appendicitis perforations rates as an indicator of access to healthcare is misleading and inappropriate. The research finds that only a small percentage of the disparity in rates of perforation between minority and white children can be explained by their socioeconomic or health insurance status.

Previous analysis indicated that higher perforation rates are found among poor and minority patients, or those who have an insufficient amount of access to health care.

The study, led by Edward H. Livingston, M.D., of the University of Texas Southwestern Medical Center, Dallas, and Robert W. Fairlie, Ph.D., of the University of California, Santa Cruz, and RAND, Santa Monica, Calif., examined over 526,925 cases of appendicitis perforation from the Healthcare Cost and Utilization Project database of hospital discharges from 2001 to 2008.

They found that there was no difference in the rates of adult perforation, yet among children the disparities were fairly substantial with a perforation rate of 26.7 percent in white children; 35.5 percent in black children; and 36.5 percent in Latino children. Through gap analysis, the researchers were able to find that insurance status only accounted for 12 percent of the difference in the rates between black and white children, and only 12.7 percent between Latino and white children.

The researchers said

"The finding that insurance type accounts for only 12 percent of the increased perforation rate between minority and white children demonstrates that insurance status contributes only minimally to appendiceal perforation in children, a fact that is not evident from consideration of odds ratios alone."

  Income level was responsible for only 7.2 percent of the disparity difference between black and white children, and 6.1 percent between white and Latino children. It should be noted that one third of the difference between Latino and white children was unaccountable by measurable variables, and two-thirds of the difference between black and white children wasn't explained.

The researchers conclude

"A very small amount of the gap between minority and white children's appendicitis rates is explained by the proxy factors for health insurance and poverty status that might relate to health care access. Appendicitis perforation rates are not an appropriate indicator of health care access."

  Written by Joseph Nordqvist
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