title: Racial disparities in the management of pediatric appenciditis.
abstract: BACKGROUND
  Our objective was to compare the racial differences in incidence and management of pediatric appendicitis.
  
  
  METHODS
  Data for this study come from two large national hospital discharge databases from the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project: The Nationwide Inpatient Sample (NIS) and the Kids' Inpatient Database (KID). Analysis was restricted to age less than 18 years with an ICD-9 diagnosis of either simple (540.9) or complex (540.0 and 540.1) appendicitis. Data were weighted to represent national estimates. Incidence was defined as the number of new disease cases divided by the number of at risk hospitalized children.
  
  
  RESULTS
  The data for this study contained an estimated 428,463 [95% confidence interval (CI) = 414, 672-442, 253] cases of appendicitis, representing approximately 65,000 to 75,000 cases annually. Multi-variant analysis suggests that African-Americans, as compared to Caucasians, were less prone to develop appendicitis [odds ratio (OR) = 0.39, 95% CI (0.38, 0.41)], but less frequently underwent laparoscopic treatment [OR = 0.78, 95% CI (0.74, 0.87)], and were more likely to have complex appendicitis [OR = 1.39, 95% CI (1.30, 1.49)]. In contrast, Hispanics were more likely than Caucasians to both develop appendicitis [OR = 1.48, 95% CI (1.41, 1.56)] and to have complex disease [OR = 1.10, 95% CI (1.05, 1.16)]. The incidence of appendicitis was less frequent in females versus males [OR = 0.69, 95% CI (0.68, 0.70)] but the likelihood of laparoscopic exploration was higher [OR = 1.39, 95% CI (1.34, 1.43)]. Finally, children with public insurance [OR = 1.25, 95% CI (1.21, 1.29)] and uninsured children [OR = 1.10, 95% CI (1.04, 1.16)] were more likely to have complex appendicitis when compared to children with private insurance.
  
  
  CONCLUSIONS
  African-American children with appendicitis have lower overall hospitalization rates, higher rates of perforation, a greater delay to surgical management, and lower laparoscopic rates. In contrast, Hispanic children more frequently had appendicitis and complex disease. The treatment of African-American and Hispanic children overall was associated with a longer hospital stay and higher charges. The lower incidence of appendicitis in African-American children is incompletely understood and the disparity in surgical management among minority children remains troubling.
authors.affiliation: Department of Surgery, Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA. kokoskaevanr@uams.edu
authors.forename: Evan R
authors.initials: ER
authors.lastname: Kokoska
authors.forename: T M
authors.initials: TM
authors.lastname: Bird
authors.forename: James M
authors.initials: JM
authors.lastname: Robbins
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Smith
authors.forename: John M
authors.initials: JM
authors.lastname: Corsi
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D007416:Intestinal Perforation / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*