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Regional variation in rates of pediatric perforated appendicitis
Samir Sarda1, Heather L Short2, Jason M Hockenberry1
1Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Insights
Pediatric perforated appendicitis rates vary by US region and insurance status. Uninsured children, particularly in the South, face higher perforation risks, highlighting the need for targeted public health strategies.
Area of Science:
- Pediatric Surgery
- Public Health
- Health Services Research
Background:
- Trends in perforated appendicitis (PA) rates have been studied, but regional disparities in pediatric admissions for PA remain unclear.
- Understanding geographic variations in PA is crucial for addressing healthcare access and outcomes.
Purpose of the Study:
- To analyze regional variations in pediatric perforated appendicitis admission rates across the United States.
- To investigate the association between insurance status and the likelihood of perforated appendicitis in children.
Main Methods:
- Retrospective, cross-sectional analysis using the 2006-2012 Kids' Inpatient Database.
- Calculation of PA rates per 1000 admissions, stratified by US region and insurance status.
- Statistical analysis to determine regional differences and the impact of insurance on perforation odds.
Main Results:
- National PA rates fluctuated between 2006 and 2012, with a significant decrease from 2006-2009 followed by an increase.
- The Northeast consistently showed the lowest PA rates, while the West and Midwest experienced statistically significant increases in PA rates between 2009-2012.
- Uninsured children had significantly higher odds of PA (OR 1.35), with the highest odds observed in the South (OR 1.57).
Conclusions:
- Geographic region and insurance status are significant factors associated with the presentation of perforated appendicitis in pediatric patients.
- Findings underscore the need for health policymakers to consider regional variations and insurance coverage when developing strategies to reduce pediatric PA.
- Targeted interventions may be necessary to address disparities in appendicitis outcomes, particularly for uninsured children in specific regions.
Background:
While trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown.
Methods:
A retrospective, cross-sectional analysis of the 2006-2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications.
Results:
National PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (p<0.001), where the increase in rates between 2009 and 2012 was only statistically significant in the Midwest [Odds Ratio (OR) 1.07; 95% Confidence Interval (95%CI) 1.03-1.12] and West (OR 1.10; 95% CI 1.07-1.14). The Northeast consistently experienced the lowest PA rates. The odds of PA were highest among uninsured patients (OR 1.35; 95% CI 1.31-1.29). The South had the highest proportion of uninsured children, and these patients had the highest odds of perforation (OR 1.57; 95% CI 1.21-2.02).
Conclusions:
For children with appendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape.
Levels Of Evidence Rating:
Level III Treatment Study - Retrospective comparative study of appendicitis presentation in children by region of the country.
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