Racial disparities in hospital admissions and surgical management of children with appendicitis T. M. Bird Child Health Services Research Group Department of Pediatrics University of Arkansas for Medical Sciences

Background Some evidence to suggest racial/ethnic differences in the rates of hospitalization for appendicitis*. Literature is dated and based on limited samples. Does not have a pediatric focus. Suspected racial/ethnic differences in hospital management of appendicitis. *Addiss, et al. (1990); Luckmann, et al. (1991)

Objectives To compare differences in the rates of pediatric hospitalizations for appendicitis among racial/ethnic groups in a large, updated sample. To compare differences in the hospital management of appendicitis among racial/ethnic groups.

Methods Kids’ Inpatient Database (KID)* Large, all-payer, nationally representative database of pediatric hospital discharge records. Years 1997 and 2000 combined. Over 4.4 million discharges. *Distributed by the Agency for Healthcare Research and Quality (AHRQ).

Methods Inclusion Criteria ICD-9 Diagnosis Codes Perforated appendicitis & Simple appendicitis 540.9, 541 & 542 Management Criteria ICD-9 Procedure Codes Laparoscopic Appendectomy Open Appendectomy 47.0 & 47.09

Rates of appendicitis per 1,000 hospitalizations by ethnic group and year of age

Rates of appendicitis per 1,000 hospitalizations by ethnicity and income level

Percentage of hospitalizations for appendicitis that are perforated by ethnicity and income level

Percentage of hospitalizations for appendicitis that undergo laparoscopic surgery by ethnicity and income level ** * * p < 0.05 ** p < 0.01

Percentage of postoperative infections by ethnicity and type of surgery, perforated appendix only * * p < 0.05

Mean length of stay by ethnicity and type of surgery * p < 0.05 ** p < 0.01 **

Odds ratios and 95% confidence intervals from logistic regression models with Caucasian as the reference group African American Hispanic Appendicitis0.69( )**3.08( )** Laparoscopy0.78( )**0.95( ) Perforation1.27( )**1.16( )** Infection1.17( ) 1.07( ) * p < 0.05 ** p < 0.01 Models controlled for income level, insurance status, gender, age and region of country.

Conclusions Hospitalization rates lowest for African Americans, highest for Hispanics. Perforation rates higher for African Americans and Hispanics Rates of laparoscopic surgery lower for African Americans and Hispanics Rates of postoperative infection higher for African Americans Mean length of stay longer for African Americans and Hispanics Differences persist across income levels.

Implications Genetics. Diet/environment. Healthcare preferences. Over management. Does appendicitis subside?

Acknowledgments Supported by grant # MM /04 from Centers for Disease Control Co-authors Evan R. Kokoska James M. Robbins

Negative appendectomy: percentage of appendectomies without corresponding diagnosis code for appendicitis * p < 0.05 ** p < 0.01 ** *

Total number of appendicitis hospitalizations by ethnic group and year of age.