• Online Features  This Article  • Full text  • PDF  • Author Interview  • CME Course for This Article  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Medical Practice  • Medical Practice, Other  • Pediatrics  • Pediatrics, Other  • Surgery  • Surgical Interventions  • Gastrointestinal/ Upper Foregut  • Pediatric Surgery  • Gastroenterology  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Edward H. Livingston, MD; Robert W. Fairlie, PhD

Arch Surg. 2012;147(1):11-17. doi:10.1001/archsurg.2011.746

Objective  To estimate how much of the gap in appendicitis perforation rates between minority and white children is explained by differences in socioeconomic and insurance factors.

Design  Observational analysis of hospital discharge information.

Setting  The Healthcare Cost and Utilization Project database.

Participants  Appendicitis perforation rates determined from the Healthcare Cost and Utilization Project database of hospital discharges from 2001 to 2008.

Main Outcome Measures  The proportion of the gap between perforation rates explained by various patient- and hospital-level variables.

Results  There were no disparities observed in adult appendicitis perforation rates. The perforation rate for white children was 26.7%; black children, 35.5%; and Latino children, 36.5%. Gap analysis showed that only 12.0% of the difference in perforation rates between black and white children was explained by insurance status and only 12.7% of the difference between Latino and white children was explained. Income level only accounted for 7.2% of the gap for black children and 6.1% for Latino children. Age explained one-third of the gap for Latino children and one-third was not accounted for by measurable variables. Two-thirds of the difference between appendicitis perforation rates between black and white children was not explained by measurable factors.

Conclusions  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.

Author Affiliations: Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, Dallas (Dr Livingston), and Department of Bioengineering, University of Texas at Arlington (Dr Livingston); and Department of Economics, University of California, Santa Cruz, and RAND, Santa Monica (Dr Fairlie).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?