Hospital type as a metric for racial disparities in pediatric appendicitis

Appendiceal perforation (AP) is a marker of health care disparities. We propose that racial disparities in children, as measured by AP, may change according to the type of hospital in which a child receives care.

Children 2 to 18 years old, with appendicitis diagnosed from 1999 to 2007, were retrospectively reviewed from the California Patient Discharge Dataset and sorted by community, children's, and county hospitals. Risk of AP within and between hospital types was analyzed with multivariate logistic regression controlling for hospital and patient level factors.

Overall, 107,727 children (white, 36%; Hispanic, 53%; black, 3%; Asian, 5%; other, 8%) were treated at 386 California hospitals (community, 74%; children's, 17%; county, 10%). Hispanic (odds ratio [OR] 1.23, 99% CI 1.16 to 1.32) and Asian (OR 1.34, 99% CI 1.19 to 1.52) children treated at community hospitals experienced increased risk of AP compared with white children. Hispanic children cared for at children's hospitals also exhibited increased odds of AP (OR 1.18, 99% CI 1.05 to 1.33). Odds of AP did not differ by race within county hospitals. When comparing AP risk between hospital types, black children treated at county (OR 1.12, 99% CI 0.90 to 1.38) and children's (OR 2.01, 99% CI 1.18 to 3.42) hospitals exhibited increased odds of AP compared with black children treated at community hospitals.

These results underscore differential patterns of AP at the hospital level and deserve immediate attention because they may reflect far larger disparities in access and quality of care for children in California. Future interventions aimed at eliminating racial disparities in children must account for racial differences in access to timely diagnostic and surgical intervention for rapidly progressive and preventable clinical conditions such as AP.