Child Opportunity and Severity of Pediatric Acute Appendicitis: A Statewide Analysis

Socioeconomic disadvantage is associated with increased disease severity and worse clinical outcomes among children with acute appendicitis. We sought to evaluate the association between neighborhood-level child opportunity and complicated appendicitis (CA) among a retrospective pediatric cohort. We hypothesized that lower neighborhood-level opportunity, measured by the Child Opportunity Index (COI), is associated with higher incidence of CA and hospital length of stay (LOS).

We performed a retrospective review of children (<18 y) with appendicitis in the North Carolina Discharge Database, from 2019 to 2021. Patients were categorized as having simple appendicitis or CA, based on the presence of perforation, gangrene, or abscess. Multivariate regression analysis was used to identify independent predictors of CA and LOS.

A total of 876 children with acute appendicitis and available zip code data were identified. Most children had public (n = 463, 52.9%) health insurance coverage. Compared to children with simple appendicitis, those with CA were significantly younger (9.9 ± 4.4 versus 11.9 ± 3.8 y; P < 0.0001), and with a higher proportion from very low (15.3% versus 12.2%) and low (23.1% versus 15.9%) COI neighborhoods. Hospital LOS was significantly longer for children with CA (3.7 ± 5.2 versus 1.6 ± 2.1 d; P < 0.001). On multivariate regression analysis, COI was not independently associated with odds of CA (adjusted odds ratio: 1.003; 95% confidence interval: 1.00-1.01) or hospital LOS (adjusted relative risk: 0.001; 95% confidence interval: -0.001 to 0.003).

In a statewide cohort of pediatric patients, COI was not independently associated with CA. Our findings suggest that high insurance coverage improves access to acute pediatric surgical care and may mitigate disparities linked to child neighborhood level opportunity.