title: The Impact of Socioeconomic Status on Appendiceal Perforation in Pediatric Appendicitis.
abstract: OBJECTIVE
  To assess the impact of socioeconomic status (SES) on pediatric appendicitis outcomes using the validated Agency for Healthcare Research and Quality (AHRQ) SES Index and incorporating block-group data.
  
  
  METHODS
  We reviewed all patients <18 years old who underwent appendectomy for acute appendicitis from 2009-2013 at our institution. Patient addresses were geocoded and linked to 2010 US Census SES block-group data to determine composite AHRQ SES Index scores based on 7 publically reported SES variables. The primary outcome was appendiceal perforation, and the impact of SES scores, age, race, and insurance status on perforation rates were assessed through regression analyses.
  
  
  RESULTS
  Of 1501 patients, 510 (34%) had perforated appendicitis. On bivariate analysis, components of the SES Index associated with an increased perforation rate included lower household income, lower percentage of adults with college education, and higher percentage of adults with <12th grade education (all P < .05). On multivariate analysis, age ≤ 10 years (OR 1.7, 95% CI 1.4-2.2) and public insurance (OR 1.5, 95% CI 1.2-2.0) were associated with increased odds of perforation.
  
  
  CONCLUSIONS
  This study used the AHRQ SES scoring system to evaluate SES and its influence on appendiceal perforation. Among our cohort of pediatric patients, the risk of perforation was multifactorial, and younger age and public insurance were stronger predictors of perforation than SES.
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX; Department of Surgical Oncology, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Hoang T
authors.initials: HT
authors.lastname: Nguyen
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Kellagher
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX; Department of Surgical Oncology, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX; Department of Surgical Oncology, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: maustin@mdanderson.org.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001062:Appendectomy; D001064:Appendicitis / Q000453:epidemiology / Q000601:surgery*; D019352:Censuses; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012923:Social Class; D013530:Surgical Wound Infection; D014481:United States / Q000453:epidemiology