Disparities in appendicitis rupture rate among mentally ill patients.
BACKGROUND
Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness.


METHODS
Using the National Health Insurance (NHI) hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix.


RESULTS
After adjusting for age, gender, ethnicity, socioeconomic status (SES) and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20-3.64). However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77-1.73) or other mental disorders (OR, 1.58; 95% CI: 0.89-2.81) was not a significant predictor for a ruptured appendix.


CONCLUSIONS
These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.
Tsay
Jen-Huoy
JH
Department of Social Work, College of Social Science, National Taiwan University, Taipei, Taiwan, R.O.C. jhtsay@ntu.edu.tw
Lee
Cheng-Hua
CH
Hsu
Yea-Jen
YJ
Wang
Pen-Jen
PJ
Bai
Ya-Mei
YM
Chou
Yiing-Jenq
YJ
Huang
Nicole
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000941:ethics; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology