Abstract
BackgroundThe U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes.MethodsWe analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome.ResultsRupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% – 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors.ConclusionThe racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable outcome for this condition as well.
Highlights
MethodsWe analyzed the Kids' Inpatient Database (KID) Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children
The U.S National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare
Kids' Inpatient Database (KID) 2000 contains 2,516,833 abstracts representing a finite population of 7,291,039 children derived from the pediatric discharges of 2,784 hospitals in 27 states during the calendar year 2000
Summary
We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. Data source This was a retrospective cohort study of the Kid's Inpatient Database (KID) 2000, a member of AHRQ's Healthcare Cost and Utilization Project (HCUP) family of databases [11]. The sampling frame includes all pediatric discharges from community, non-rehabilitation hospitals in the HCUP State Inpatient Databases (SID) that could be matched to American Hospital Association survey data It is from the latter that KID derives hospital characteristics for each discharge. The sampling design and weighting details are described elsewhere [11]
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