title: Using appendiceal perforation rates to measure impact of a disaster on healthcare system effectiveness.
abstract: OBJECTIVE
  To understand baseline inequities in appendiceal perforation rates and the impact of hurricane destruction on the healthcare system with respect to perforation rates and racial disparities.
  
  
  METHODS
  We used claims data extracted from Medicaid Analytic Extract files to identify appendicitis diagnoses in children and adolescents based on International Classification of Diseases-9 codes and appendectomy procedures based on Current Procedural Terminology codes in the hurricane-affected states of Mississippi and Louisiana. County-level summary data obtained from 2005 Area Resource Files were used to determine high and low hurricane-affected areas. We estimated logistic regression models, mutually adjusting for race, sex, and age, to examine disparities and mixed logistic regression models to determine whether county-level effects contributed to perforation rates.
  
  
  RESULTS
  There were nine counties in the high-impact area and 133 counties in the low-impact area. Living in the high- or low-impact area was not associated with a statistically different rate of perforation before or after Hurricane Katrina; however, living in the high-impact area was associated with a change from a lower risk (odds ratio [OR] 0.62) of perforation prehurricane to a higher risk (OR 1.14) posthurricane compared with those living in the low-impact areas. African Americans had statistically higher perforation rates than whites in the high-impact areas both before (OR 1.46) and after (OR 1.71) Hurricane Katrina.
  
  
  CONCLUSIONS
  Health professionals and hospital systems were able to maintain effective levels of care before and after Hurricane Katrina; however, perforation rates in African Americans suggest ongoing racial disparities during disasters.
authors.affiliation: Morehouse College School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310-1495, USA. dmack@msm.edu
authors.forename: Dominic
authors.initials: D
authors.lastname: Mack
authors.forename: George Staben
authors.initials: GS
authors.lastname: Rust
authors.forename: Peter
authors.initials: P
authors.lastname: Baltrus
authors.forename: Barbara
authors.initials: B
authors.lastname: Moore
authors.forename: Charles
authors.initials: C
authors.lastname: Sow
authors.forename: Vijaykumar
authors.initials: V
authors.lastname: Patel
authors.forename: Dwayne
authors.initials: D
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000453:epidemiology / Q000208:ethnology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D055867:Cyclonic Storms; D004189:Disaster Planning; D004190:Disasters; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008922:Mississippi / Q000453:epidemiology; D015999:Multivariate Analysis; D012111:Residence Characteristics; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data