L. G. Souza Mota1, M. F. Nunez3, G. Ortega2,3, C. M. Smith1, D. S. Rhee4, D. D. Tran2,3 1Howard University College Of Medicine,Washington, DC, USA 2Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 3Howard University College Of Medicine,Clive O. Callender, MD Howard-Harvard Outcomes Research Center/Department Of Surgery,Washington, DC, USA 4Johns Hopkins University School Of Medicine,Division Of Pediatric Surgery/Johns Hopkins Children’s Center,Baltimore, MD, USA
Introduction: Children from lower socioeconomic status often experience longer wait times for elective surgery between diagnosis and the operating room, and are even less likely to undergo these procedures. The objective of this study is to investigate socioeconomic disparities among children with umbilical hernias presenting to the Emergency Department by analyzing a national dataset.
Methods: A retrospective review utilizing the Nationwide Emergency Department Sample from 2009 to 2014 was performed. Patients under 18 with a diagnosis of umbilical hernia were selected. Hernias were categorized as uncomplicated and complicated. Insurance status and median household income were analyzed in unadjusted and adjusted models for the likelihood of presenting with an uncomplicated umbilical hernia to the emergency department.
Results: A total of 31,327 pediatric patients with an umbilical hernia were identified. Of these patients 56.4% were male. Most of the patients were diagnosed with uncomplicated umbilical hernia (97%). Of which 20.3% had private insurance, 68.7% public, and 8.1% were uninsured. With respect to median household income (MHI), 42.1% were in the first quartile, 27.6% in the second, 19.2% in the third, and 11.2% in the fourth. Three percent of the population had a diagnosis of complicated umbilical hernia, of which 34.7% had private insurance, 56.0% public, and 6.5% uninsured. 34.9% were in the first MHI quartile, 26.3% in the second, 21.2% in the third, and 17.7% in the fourth. On multivariate analysis, uninsured patient and patients using public insurance were more likely to present to the emergency department with an uncomplicated umbilical hernia compared to private insurance, (OR 1.70 95%CI 1.22-2.38) and (OR 1.69 95%CI 1.40-2.04), respectively. Patients in the first and second MHI quartiles were also more likely to present with uncomplicated umbilical hernias compared to highest MHI quartile, (OR 1.42 95%CI 1.10-1.82) and (OR 1.40 95%CI 1.08-1.82), respectively.
Conclusion: Pediatric patients who were uninsured, had public insurance, or of lower MHI were more likely to present to the emergency department with an uncomplicated umbilical hernia. This may represent a lack of access for publicly insured and uninsured pediatric patients resulting in utilization of the emergency department for non-emergent surgical care.