L. M. Fluke1, A. Peruski2, C. Shibley2, B. Adams2, S. Stinnette2, R. Ricca1 1Naval Medical Center Portsmouth,Pediatric Surgery,Portsmouth, VA, USA 2Navy And Marine Corps Public Health Center,Health Analysis Department,Portsmouth, VA, USA
Introduction:
Disparity in healthcare due to bias caused by racial differences and socioeconomic status has been reported in the management of appendicitis. Passage of the Affordable Care Act has improved access to healthcare across the United States. TRICARE is a nationwide managed care program for the military that provides equal access to healthcare independent of race or socioeconomic status. Perforated appendicitis (PA) in children is used as an index for barriers to care as it is thought to result from delays in treatment. We evaluated the effect of racial and socioeconomic differences on the likelihood of PA to determine if a disparate level of care exists in an equal access national healthcare system.
Methods:
Retrospective review of pediatric patients who underwent appendectomy from October 2010 through September 2015 was performed after Institutional Review Board approval was obtained. Data was collected from the Military Health System Data Repository. TRICARE patients aged 6 months to 17 years who underwent appendectomy in the continental United States were included. Logistic regression was used to examine the association between ethnicity, age, gender, marital status and deployment status of the active duty parent, distance from child’s home to facility performing the appendectomy, type of facility and type of admission with the odds of having a perforated appendix.
Results:
A total of 3,124 children met inclusion criteria. The majority of children were non-Hispanic white, males with an average age of 10.5 years, and had sponsors who were married, senior enlisted, and not deployed at the time of their appendicitis diagnosis. Most children were admitted based on a referral from another source (e.g. clinic). One-third of patients had the diagnosis of PA. There was no difference in odds of having a perforated appendix based on ethnicity. Children of a single active duty parent or admitted from another institution had significantly higher odds of perforated appendicitis. Additionally, there is a decrease in the odds of having a perforated appendix for every year increase in the child’s age for enlisted personnel and senior officers (Table 1).
Conclusion:
In a national healthcare system, no healthcare disparity was found based upon race with regards to perforated appendicitis. Increased odds of perforated appendicitis persist in younger patients with lower socioeconomic status despite equal access to care. Preventive efforts focused on ease of access should be explored.
