Appendicitis racial disparities mostly unexplained

Poverty and unfavorable health insurance account for only a small portion of the gap in the number of white versus Hispanic or black children who end up with a burst appendix, according to a new study.

Some previous research has explained the fact that black and Hispanic children are more likely to have their appendix rupture by pointing to signs of poor health care access, including being uninsured, having public assistance insurance or having a low socioeconomic status.

But the latest report finds that the main reasons for these disparities "are anybody's guess," said lead author Dr. Edward Livingston, a professor at the University of Texas Southwestern Medical Center in Dallas who analyzed more than half a million hospital admissions for appendicitis.

The condition means inflammation of the appendix, a pocket of tissue attached to the intestine, and in some cases the little organ can rupture. To prevent severe infections, quick surgery is needed to remove the appendix before it bursts.

Among adults, Livingston and a colleague found no differences between white, black or Hispanic patients in the proportion of those whose appendix had burst before they could get surgery.

Children, however, did show differences depending on their race: 27 out of every 100 white kids, 35 out of every 100 black kids, and 36 out of every 100 Hispanic kids had a ruptured appendix.

Medicaid insurance - the government-subsidized health insurance for the poor - was associated with having a burst appendix, as was poverty itself.

But when Livingston and his partner looked at the numbers more closely, they found that health insurance explained only 12 percent and family income explained only seven percent of the difference between the white and black children.

Results There were no disparities observed in adult appendicitis perforation rates. The perforation rate for white children was 26.7%; black children, 35.5%; and Latino children, 36.5%. Gap analysis showed that only 12.0% of the difference in perforation rates between black and white children was explained by insurance status and only 12.7% of the difference between Latino and white children was explained. Income level only accounted for 7.2% of the gap for black children and 6.1% for Latino children. Age explained one-third of the gap for Latino children and one-third was not accounted for by measurable variables. Two-thirds of the difference between appendicitis perforation rates between black and white children was not explained by measurable factors.

Conclusions A very small amount of the gap between minority and white children's appendicitis rates is explained by the proxy factors for health insurance and poverty status that might relate to health care access. Appendicitis perforation rates are not an appropriate indicator of health care access.