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The Impact of Socioeconomic Status on Appendiceal Perforation in Pediatric Appendicitis

Luke R Putnam1, KuoJen Tsao2, Hoang T Nguyen3

  • 1Department of Pediatric Surgery, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX.

The Journal of Pediatrics
|February 29, 2016
PubMed

Insights

In pediatric appendicitis, younger age and public insurance were stronger predictors of perforation than socioeconomic status (SES). This study used the Agency for Healthcare Research and Quality (AHRQ) SES Index to analyze perforation risk factors.

Area of Science:

  • Pediatric Surgery
  • Health Services Research
  • Socioeconomic Determinants of Health

Background:

  • Appendicitis is a common surgical emergency in children.
  • Socioeconomic status (SES) may influence health outcomes, but its specific impact on pediatric appendicitis perforation rates requires further investigation.
  • The Agency for Healthcare Research and Quality (AHRQ) Socioeconomic Status (SES) Index provides a validated measure for assessing socioeconomic factors.

Purpose of the Study:

  • To evaluate the association between socioeconomic status (SES), using the AHRQ SES Index, and the risk of appendiceal perforation in pediatric patients.
  • To identify demographic and insurance-related factors that predict appendiceal perforation in children.

Main Methods:

  • Retrospective review of 1501 pediatric patients (<18 years) who underwent appendectomy for acute appendicitis (2009-2013).
  • Geocoding of patient addresses to link with 2010 US Census block-group data for AHRQ SES Index calculation.
  • Multivariate regression analysis to assess the impact of SES scores, age, race, and insurance status on appendiceal perforation.

Main Results:

  • Of 1501 patients, 34% experienced appendiceal perforation.
  • Bivariate analysis indicated that lower household income and lower educational attainment were associated with increased perforation risk.
  • Multivariate analysis revealed that younger age (≤10 years) and public insurance were significant predictors of perforation (OR 1.7 and 1.5, respectively).

Conclusions:

  • The AHRQ SES Index was utilized to assess socioeconomic factors in pediatric appendicitis.
  • While some SES components showed bivariate associations with perforation, younger age and public insurance emerged as stronger independent predictors.
  • Appendiceal perforation risk in pediatric patients is multifactorial, with age and insurance status playing a more significant role than SES in this cohort.
Abstract

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