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Evaluation of disparity in care for perforated appendicitis in a universal healthcare system

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Abstract

Purpose

Racial and socioeconomic disparities have been reported in the management of appendicitis. Perforated appendicitis (PA) is used as an index for barriers to care due to delays in treatment. This study evaluates the effect of racial and socioeconomic differences on the likelihood of PA in a universally insured national healthcare system.

Methods

A retrospective review of pediatric patients enrolled in TRICARE who underwent appendectomy during a 5-year period was performed. Logistic regression was used to examine the association between ethnicity, age, gender, parent, or guardian marital status and deployment status of the active duty parent, type of facility, and type of admission with the odds of perforated appendicitis.

Results

A total of 3124 children met inclusion criteria. One-third of children carried the diagnosis of PA. Increased odds of PA was associated with younger age of patient among children of military personnel with enlisted ranks and senior officer ranks.

Conclusion

In a universal healthcare system, no disparities across race with regard to presentation of appendicitis were identified. Increased odds of perforated appendicitis were observed in younger patients, but this was demonstrated in families of both high and low socioeconomic status. Universal coverage does appear to eliminate some barriers to healthcare.

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References

  1. Papandria D, Goldstein SD, Rhee D, Salazar JH, Arlikar J, Gorgy A, Orgeta G, Zhang Y, Abdullah F (2013) Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res 184(2):723–729

    Article  Google Scholar 

  2. Brender JD, Marcuse EK, Koepsell TD, Hatch EI (1985) Childhood appendicitis: factors associated with perforation. Pediatrics 76(2):301–305

    CAS  PubMed  Google Scholar 

  3. Short SS, Liou DZ, Singer MB, Bloom MB, Margulies DR, Bukur M, Salim A, Ley EJ (2013) Insurance type, not race, predicts mortality after pediatric trauma. J Surg Res 184:383–387

    Article  Google Scholar 

  4. Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM (2015) Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. https://doi.org/10.1001/jamapediatrics.2015.1915

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bratton SL, Haberkern CM, Waldhausen JH (2000) Acute appendicitis risks of complications: age and medicaid insurance. Pediatrics 106:75–78

    Article  CAS  Google Scholar 

  6. Braveman P, Schaaf VM, Egerter S, Bennett T, Schecter W (1994) Insurance-related differences in the risk of ruptured appendix. N Engl J Med 331(7):444–449

    Article  CAS  Google Scholar 

  7. Boomer L, Freeman J, Landrito E, Feliz A (2010) Perforation in adults with acute appendicitis linked to insurance status, not ethnicity. J Surg Res 163(2):221–224

    Article  Google Scholar 

  8. Paquette IM, Zuckerman R, Finlayson SR (2011) Perforated appendicitis among rural and urban patients: implications of access to care. Ann Surg 253(3):534–538

    Article  Google Scholar 

  9. Jablonski KA, Guagliardo MF (2005) Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access. Population Health Metrics 3:4. https://doi.org/10.1186/1478-7954-3-4

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zwintscher NP, Steele SR, Martin MJ, Newton CR (2014) The effect of race on outcomes for appendicitis in children: a nationwide analysis. Am J Surg 207(5):748–753

    Article  Google Scholar 

  11. Guagliardo MF, Teach SJ, Huang ZJ, Chamberlain JM, Joseph JG (2003) Racial and ethnic disparities in pediatric appendicitis rupture rate. Acad Emerg Med 10(11):1218–1227

    Article  Google Scholar 

  12. Kokoska ER, Bird TM, Robbins JM, Smith SD, Corsi JM, Campbell BT (2007) Racial disparities in the management of pediatric appendicitis. J Surg Res 137:83–88

    Article  Google Scholar 

  13. Livingston EH, Fairlie RW (2012) Little effect of insurance status or socioeconomic condition on disparities in minority appendicitis perforation rates. Arch Surg 147(1):11–17

    Article  Google Scholar 

  14. Nwomeh B, Chisolm DJ, Caniano DA et al (2006) Racial and socioeconomic disparity in perforated appendicitis among children: where is the problem? Pediatrics 117(3):870–875

    Article  Google Scholar 

  15. Lee SL, Shekherdimian S, Chiu VY, Sydorak RM (2010) Perforated appendicitis in children: equal access to care eliminates racial and socioeconomic disparities. J Pediatr Surg 45:1203–1207

    Article  Google Scholar 

  16. Lee SL, Shekherdimian S, Chiu VY (2011) Effect of race and socioeconomic status in the treatment of appendicitis in patients with equal healthcare access. Arch surg 146(2):156–161

    Article  Google Scholar 

  17. Kelley-Quon LI, Tseng CH, Jen HC, Lee SL, Shew SB (2013) Hospital type as a metric for racial disparities in pediatric appendicitis. J Am Coll Surg 216(1):74–82

    Article  Google Scholar 

  18. Almaramhy HH (2017) Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr 43:15. https://doi.org/10.1186/s13052-017-0335-2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee SL, Yaghoubian A, Stark R, Sydorak RM, Kaji A (2012) Are there differences in access to care, treatment, and outcomes for children with appendicitis treated at country versus private hospitals? Perm J 16(1):4–6

    Article  Google Scholar 

  20. Maclean A (2008) The privileges of rank: the peacetime draft and later-life attainment. Armed forces and society 34:682–713. https://doi.org/10.1177/0095327x07310336

    Article  PubMed  PubMed Central  Google Scholar 

  21. Maclean A, Edwards RD (2010) The pervasive role of rank in the health of US veterans. Armed forces and society 36:765–785. https://doi.org/10.1177/0095327x09356166

    Article  PubMed  PubMed Central  Google Scholar 

  22. Blattner M, Price J, Holtkamp MD (2018) Socioeconomic class and universal healthcare: analysis of stroke cost and outcomes in US military healthcare. J Neurol Sci 386:64–68. https://doi.org/10.1016/j.jns.2018.01.018

    Article  PubMed  Google Scholar 

  23. Dorrance KA, Ramchandani S, Neil N, Fisher H (2013) Leveraging the military health system as a laboratory for health care reform. Mil Med 178:142–145

    Article  Google Scholar 

  24. Gimbel RW, Pangaro L, Barbour G (2010) America’s, “undiscovered” laboratory for health services research. Med Care 48:751–756. https://doi.org/10.1097/MLR.0b013e3181e35be8

    Article  PubMed  Google Scholar 

  25. Hutchinson JMR, Koehlmoos TP, DeLeon PH (2016) Lessons for health equity: military medicine as a window to universal health insurance. National Academy of Medicine, Washingon

    Google Scholar 

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Funding

This study required no specific funding.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA

    Laura M. Fluke, Christian S. McEvoy & Robert L. Ricca

  2. Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Laura M. Fluke, Christian S. McEvoy & Robert L. Ricca

  3. Health Analysis Department, Navy and Marine Corps Public Health Center, Portsmouth, VA, 23708, USA

    Christian S. McEvoy, Anne H. Peruski, Christina A. Shibley, Brian T. Adams & Samuel E. Stinnette

Authors
  1. Laura M. Fluke
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  2. Christian S. McEvoy
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  3. Anne H. Peruski
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  4. Christina A. Shibley
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  5. Brian T. Adams
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  6. Samuel E. Stinnette
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  7. Robert L. Ricca
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Contributions

Primary author LMF contributed to literature search, IRB protocol writing, data interpretation, and writing. AHP, CAS, BTA, CSM, and SES contributed to study design and data collection and analysis. CSM and RLR, as the senior author, contributed with study design, data interpretation, and critical review.

Corresponding author

Correspondence to Robert L. Ricca.

Ethics declarations

Conflict of interest

Laura Fluke declares that she has no conflict of interest. Christian McEvoy declares that he has no conflict of interest. Anne Peruski declares that she has no conflict of interest. Christina Shibley declares that she has no conflict of interest. Brian Adams declares that he has no conflict of interest. Samuel Stinnette declares that he has no conflict of interest. Robert Ricca declares that he has no conflict of interest.

Ethical approval

This study is a retrospective review and does not contain any procedures or studies with human participants performed by any of the authors.

Informed consent

This was a retrospective database review. Informed consent was not required.

Disclosures

The authors of this study have no financial disclosures to report. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, The United States Navy, United States Air Force, or the United States Government. Research data derived from an approved Naval Medical Center, Portsmouth, VA IRB protocol. I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties

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Appendices

Appendix A. Appendicitis diagnosis

540.9

Acute appendicitis without mention of peritonitis

541

Appendicitis, unqualified

542

Other appendicitis

543

Hyperplasia of appendix

543.9

Other and unspecified diseases of appendix

Appendix B. Perforated appendicitis diagnosis codes

540

Acute appendicitis with generalized peritonitis

540.1

Acute appendicitis with peritoneal abscess

567.2

Other suppurative peritonitis

569.5

Abscess of intestine

614.3

Acute parametritis and pelvic cellulitis

614.4

Chronic or unspecified parametritis and pelvic cellulitis

Appendix C. Appendectomy procedure codes

47.01

Laparoscopic appendectomy

47.09

Other appendectomy

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Fluke, L.M., McEvoy, C.S., Peruski, A.H. et al. Evaluation of disparity in care for perforated appendicitis in a universal healthcare system. Pediatr Surg Int 36, 219–225 (2020). https://doi.org/10.1007/s00383-019-04585-z

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  • DOI: https://doi.org/10.1007/s00383-019-04585-z

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