title: Pediatric appendicitis rupture rate: disparities despite universal health care.
abstract: OBJECTIVE
  Significant socioeconomic disparities have been observed in the rates of perforated appendicitis among children in private health care. We seek to explore if, in the Canadian system of public, universal health care access, pediatric appendicitis rupture rates are an indicator of health disparities.
  
  
  METHODS
  Using the Population Health Research Data Repository housed at Manitoba Centre for Health Policy, a retrospective analysis over a 20-year period (1983-2003) examined all patients aged less than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes for appendicitis (N = 7475). Multivariate logistic regression analysis was used to calculate odds ratios in the association between appendiceal rupture rates and the patient's socioeconomic status (SES) based upon average household income of the census area adjusted for age, sex, area of residence, and treating hospital.
  
  
  RESULTS
  The overall appendiceal rupture rate was 28.8%. Significant positive predictors of appendiceal rupture were lower rural SES, lower urban SES, younger age, northern area of residence, and receiving treatment at the province's only pediatric tertiary care hospital.
  
  
  CONCLUSIONS
  Despite free, universal access health care, children from lower SES areas have increased appendiceal rupture rates. Seeking and accessing medical attention can be complicated by social, behavioral, and geographical problems.
authors.affiliation: Department of Pediatric General Surgery, Faculty of Medicine, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada. bratu@ualberta.ca
authors.forename: Ioana
authors.initials: I
authors.lastname: Bratu
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Natalia
authors.initials: N
authors.lastname: Dik
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
authors.forename: Alan
authors.initials: A
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000453:epidemiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000453:epidemiology / Q000601:surgery; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data