title: Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001-2003.
abstract: BACKGROUND
  Rural-urban disparities in health and healthcare are often attributed to differences in geographic access to care and health seeking behavior. Less is known about the differences between rural locations in health care seeking and outcomes. This study examines how commuting patterns in different rural areas are associated with perforated appendicitis.
  
  
  RESULTS
  Controlling for age, sex, insurance type, comorbid conditions, socioeconomic status, appendectomy rates, hospital type, and hospital location, we found that patient residence in a rural ZIP code with significant levels of commuting to metropolitan areas was associated with higher risk of perforation compared to residence in rural areas with commuting to smaller urban clusters. The former group was more likely to seek care in an urbanized area, and was more likely to receive care in a Children's Hospital.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to differentiate rural dwellers with respect to outcomes associated with appendicitis as opposed to simply comparing "rural" to "urban". Risk of perforated appendicitis associated with commuting patterns is larger than that posed by several individual indicators including some age-sex cohort effects. Future studies linking the activity spaces of rural dwellers to individual patterns of seeking care will further our understanding of perforated appendicitis and ambulatory care sensitive conditions in general.
authors.affiliation: The Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, 700 Children's Drive, Columbus, OH 43205, USA. robert.penfold@nationwidechildrens.org
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.forename: Deena J
authors.initials: DJ
authors.lastname: Chisolm
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics / Q000639:trends; D001064:Appendicitis / Q000191:economics* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006761:Hospitals / Q000639:trends; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D012307:Risk Factors; D012423:Rural Health / Q000639:trends*; D012959:Socioeconomic Factors; D014504:Urban Health / Q000639:trends*; D055815:Young Adult