title: Effects of race, insurance status, and hospital volume on perforated appendicitis in children.
abstract: 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.
authors.affiliation: Department of Surgery, Children's Hospital Boston, Boston, Massachusetts, USA. dsmink@partners.org
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Smink
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishman
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
mesh_terms: D000208:Acute Disease; D001064:Appendicitis / Q000208:ethnology / Q000209:etiology*; D002648:Child; D015331:Cohort Studies; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008484:Medicaid; D008913:Minority Groups; D044469:Racial Groups; D012189:Retrospective Studies