Elsevier

Journal of Pediatric Surgery

Volume 43, Issue 11, November 2008, Pages 1964-1969
Journal of Pediatric Surgery

Orignal articles
Pediatric appendicitis rupture rate: disparities despite universal health care

https://doi.org/10.1016/j.jpedsurg.2008.05.013Get rights and content

Abstract

Background/Purpose

Significant socioeconomic disparities have been observed in the rates of perforated appendicitis among children in private health care. We seek to explore if, in the Canadian system of public, universal health care access, pediatric appendicitis rupture rates are an indicator of health disparities.

Methods

Using the Population Health Research Data Repository housed at Manitoba Centre for Health Policy, a retrospective analysis over a 20-year period (1983-2003) examined all patients aged less than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes for appendicitis (N = 7475). Multivariate logistic regression analysis was used to calculate odds ratios in the association between appendiceal rupture rates and the patient's socioeconomic status (SES) based upon average household income of the census area adjusted for age, sex, area of residence, and treating hospital.

Results

The overall appendiceal rupture rate was 28.8%. Significant positive predictors of appendiceal rupture were lower rural SES, lower urban SES, younger age, northern area of residence, and receiving treatment at the province's only pediatric tertiary care hospital.

Conclusion

Despite free, universal access health care, children from lower SES areas have increased appendiceal rupture rates. Seeking and accessing medical attention can be complicated by social, behavioral, and geographical problems.

Section snippets

Methods

This 20-year retrospective study examined all patients 18 years or younger who were residing in the province of Manitoba and had acute appendicitis (N = 7475), simple or ruptured, during the fiscal years 1983-2003. The age categories (0-4 vs 5-9 vs 10-14 vs 15-18 years) were chosen based on previous studies [7]. Previous work has validated the use of administrative health data for distinguishing ruptured from nonruptured appendicitis [5], [7], [8], [9], [10], [11], [12], [13]. Total

Results

Of the total appendectomies (N = 7475), 5334 were deemed simple/nonperforated appendicitis, and 2141 were ruptured appendicitis. The overall proportion of ruptured appendicitis (as a fraction of all appendectomies) was 28.8%, with a significant positive trend from 1983 to 2003 for the proportion of ruptured appendicitis (P < .0001). The total appendectomy rate per 1000 pediatric population per year was 1.16 with 95% confidence intervals (CIs) of 1.13-1.18. There was a significant negative trend

Discussion

From 1983 to 2003, significant positive predictors of appendiceal rupture in Manitoba children were the following: lower rural SES, lower urban SES, younger age, northern area of residence, and receiving treatment at the province's only pediatric tertiary care hospital. Despite free, universal access health care, children from lower SES had increased appendiceal rupture rates, both in urban and rural areas.

Similar to our results, others have shown in the United States that higher appendicitis

Acknowledgments

This study was supported by a grant from the Winnipeg Health Sciences Centre Hospital Foundation. Approval for this study was obtained from the Health Information Privacy Committee of Manitoba Health (file no. 2006/2007-12), the Research Ethics Board of the University of Manitoba, the HSC and Children's Hospital research board, and the Manitoba Centre for Health Policy research board. We are indebted to Manitoba Health for providing data. The results and conclusions are those of the authors,

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