Hospital Type Linked to Racial Disparities in Kids With Appendicitis Complication

Cases of perforated appendix may signal inadequate access to health care, researchers say.

FRIDAY, Jan. 4 (HealthDay News) -- The type of hospital in which minority children with appendicitis receive care may affect their chances of developing a perforated or ruptured appendix, according to a new study.

However, the study authors said that more research is needed to explain why this racial disparity exists and what steps can be taken to prevent it.

If not treated within one or two days, appendicitis can lead to a perforated appendix. As a result, this painful condition can serve as a marker for inadequate access to health care, the UCLA Medical Center researchers explained in a news release from the American College of Surgeons.

"Appendicitis is a time-dependent disease process that leads to a more complicated medical outcome, and that outcome, perforated appendicitis, has increased hospital costs and increased burden to both the patient and society," according to study author Dr. Stephen Shew, an associate professor of surgery at UCLA Medical Center, and a pediatric surgeon at Mattel Children's hospital in Los Angeles.

In conducting the study, Shew's team examined discharge data on nearly 108,000 children aged 2 to 18 who were treated for appendicitis at 386 California hospitals between 1999 and 2007. Of the children treated, 53 percent were Hispanic, 36 percent were white, 3 percent were black, 5 percent were Asian and 8 percent were of an unknown race.

The researchers divided the children into three groups based on where they were treated: a community hospital, a children's hospital or a county hospital.

After taking age, income level and other risk factors for a perforated appendix into account, the investigators found that among kids treated at community hospitals, Hispanic children were 23 percent more likely than white children to experience this condition. Meanwhile, Asian children were 34 percent more likely than whites to have a perforated appendix.

Among the children treated at children's hospitals, the Hispanic children were 18 percent more likely to experience this complication than white children.

The racial disparity was not found at county hospitals. The study authors noted, however, that black patients treated at children's and county hospitals had a higher risk for a perforated appendix than other black children treated at community hospitals.

"The goal is to figure out why these racial disparities exist and what interventions could be put in place to help eliminate them," Shew said in the news release. He added that more research is needed on this topic, including if language barriers prevent access to care or affect patients' understanding of their symptoms.

"We don't know what explains these findings; however we suspect that there are some other barriers in play," Shew said. "As investigators it behooves us to look further into prehospital factors that may contribute to this racial disparity and ultimately find what interventions can be implemented to provide much quicker access to care, so children can get treated more effectively."

An estimated 80,000 children in the United States develop appendicitis each year. The condition is the most common reason for emergency abdominal surgery in children, according to background information in the news release.

The study was published in the January issue of the Journal of American College of Surgeons.

More information

The U.S. National Library of Medicine has more about health disparities.