Delay in treatment is a strong risk factor for perforation during acute appendicitis.
In addition, lower socioeconomic status has been linked to impaired access to surgical care.
Dr Fredric Pieracci and colleagues from New York, USA examined the relationships among race, insurance status, and perforation in a recent, adult population with acute appendicitis.
|Uninsured patients were more likely to have perforation|
|Journal of the American College of Surgeons|
The team abstracted data on adult patients with acute appendicitis from the New York State Statewide Planning and Cooperative Systems Database for the years 2003 and 2004.
The team used a multiple logistic regression model, which adjusted for patient, community, and hospital factors.
This model was used to examine the independent effects of both race and insurance status on likelihood of perforation.
The researchers found that a total of 29,637 patients had acute appendicitis, of which 27% were perforated.
Although Caucasian patients were more likely to perforate compared with minority patients, by univariate analysis, adjustment for age alone eliminated this disparity.
In addition, by multivariable analysis, no difference existed in odds of perforation for Caucasian patients compared with African-American, Hispanic, or Asian patients.
The team noted that, compared with privately insured patients, uninsured patients, Medicaid patients, and Medicare patients were more likely to have perforation.
Dr Pieracci's team concluded, "Race does not appear to be an important variable in predicting perforation in adult patients with acute appendicitis."
"However, the likelihood of perforation varies significantly according to insurance status."
"Future research is necessary to both understand and have an impact on this socioeconomic disparity."