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Racial and ethnic disparities in pediatric appendicitis rupture rate
Mark F Guagliardo1, Stephen J Teach, Zhihuan J Huang
1George Washington University School of Medicine and Health Sciences, Children's National Medical Center, Washington, DC 20010, USA. mguaglia@cnmc.org
Insights
Racial and ethnic disparities in appendiceal rupture exist in children, suggesting unequal access to emergency care. Immigrant children appear most vulnerable to delayed diagnosis and treatment.
Area of Science:
- Pediatric Emergency Medicine
- Health Disparities Research
- Public Health Policy
Background:
- Appendiceal rupture in children is often linked to delayed diagnosis, indicating potential issues with emergency care access.
- Understanding racial and ethnic variations in rupture rates can highlight systemic inequities in healthcare delivery.
Purpose of the Study:
- To investigate racial and ethnic differences in appendiceal rupture rates among children in California and New York.
- To identify if these disparities are associated with socioeconomic, hospital, or admission factors.
Main Methods:
- Observational, cross-sectional analysis of acute appendicitis cases in children aged 4-18.
- Comparison of rupture risk across racial/ethnic groups, adjusting for biological, socioeconomic, hospital, and admission variables.
- Interpretation of results considering census data on immigrant populations within each state.
Main Results:
- Hispanic and Asian children in California, and Asian and Black/African American children in New York, showed higher odds of appendiceal rupture compared to white children.
- These disparities correlated with the proportion of immigrant children within these groups in each state.
- Adjustments for various factors reduced but did not eliminate the observed racial/ethnic disparities.
Conclusions:
- Significant racial/ethnic disparities in appendiceal rupture rates were identified in two large, diverse states.
- Immigrant children may face heightened risks due to delayed emergency care.
- Further research is recommended to explore immigration and acculturation as risk factors for appendicitis rupture in pediatric populations.
Objectives:
To determine if there are racial/ethnic differences in the rates of appendiceal rupture among the children of two large states. Because rupture is primarily due to delayed diagnosis, differences would suggest disparities in timely access to quality emergency care.
Methods:
This was an observational, cross-sectional analysis of full-year samples of acute appendicitis cases from California and New York children 4 to 18 years old. Racial/ethnic groups were compared for risk of appendiceal rupture adjusted for biological factors both before and after adjustment for the following socioeconomic, hospital, and admission characteristics: income, insurance, hospital type, and admission source. Results were interpreted in light of census data on the proportion of immigrants in each racial/ethnic group.
Results:
Compared with white children with acute appendicitis, Hispanic and Asian children have higher odds of rupture in California, whereas Asian and black/African American children have higher odds in New York. These differences roughly parallel the within-state proportion of immigrant children in these groups. Adjustments for family, socioeconomic, and hospital characteristics attenuate but do not eliminate disparities.
Conclusions:
The authors found evidence of significant racial/ethnic disparities in rate of appendiceal rupture, an important and preventable outcome, in two large but dissimilar states. Immigrant groups may be most at risk for delayed emergency care. Future research should focus on immigration and acculturation as risk factors for appendicitis rupture in children.
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