Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 920-925 (doi:10.1542/10.1542/peds.2004-1363)

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Effects of Race, Insurance Status, and Hospital Volume on Perforated Appendicitis in Children

Douglas S. Smink, MD, MPH^*,,, Steven J. Fishman, MD^*, Ken Kleinman, ScD^|| and Jonathan A. Finkelstein, MD, MPH^,||,¶

^* Department of Surgery
Harvard Pediatric Health Services Research Fellowship
^¶ Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
^|| Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts

Objective. Previous research suggests that perforated appendicitis is more common in Medicaid patients, but the roles of minority race and hospital volume remain largely unstudied. We sought to investigate the association of perforated appendicitis in children with minority race, insurance status, and hospital volume.

Methods. We conducted a retrospective, population-based cohort study of 33184 children who had an International Classification of Diseases, Ninth Revision diagnosis code for acute appendicitis in The Kids' Inpatient Database, a pediatric database from 22 states in 1997. A multivariate logistic regression model was developed to determine patient and hospital characteristics predictive of perforated appendicitis.

Results. Of 33184 children with acute appendicitis, 10777 (32.5%) were perforated. In multivariate analysis, black (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 1.10–1.39) and Hispanic (OR: 1.19; 95% CI: 1.10–1.29) children were more likely to have perforated appendicitis than white children. Perforation was also more likely in Medicaid patients (OR: 1.30; 95% CI 1.22–1.39) compared with privately insured children. Annual hospital volume of cases of appendicitis was not significantly associated with perforation in multivariate analysis.

Conclusions. Perforated appendicitis disproportionately affected both children of minority race and children insured by Medicaid. No effect of hospital volume was observed. To reduce this racial disparity, efforts should focus on the causes of delayed diagnosis and the treatment of appendicitis in children of minority race.

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Key Words: appendicitis • perforation • race • outcome

Abbreviations: KID, Kids' Inpatient Database • LOS, length of stay • OR, odds ratio • CI, confidence interval

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Accepted Aug 30, 2004.

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