Orignal articlesPediatric appendicitis rupture rate: disparities despite universal health care
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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