G. J. Lee1, C. Ezeibe2, C. Zogg2, A. H. Haider2, G. Ortega2 1Harvard School Of Public Health,Health Policy,Boston, MA, USA 2Center for Surgery and Public Health,Department Of Surgery,Boston, MA, USA
Introduction: Socioeconomic status plays a direct factor in accessibility to consistent health services and various studies have examined its outcomes on surgical care in adults. Our study aims to evaluate the impact of socioeconomic status on mortality among children in a national database.
Methods: We utilized the Kids' Inpatient Database for the year 2012 and selected children who underwent a surgical procedure and were admitted with a primary emergency general surgery (EGS) diagnosis. Patients without insurance or median household income (MHI) data were excluded. Patients were stratified by insurance status (Private, Medicaid, Uninsured) and MHI quartile. Multivariable logistic regression was performed with moratility as the outcome for each insurance and MHI group while adjusting for patient and hospital charactersitics.
Results:
137,013 met our inclusion criteria, with mean age 11.1 years (SD=6.7), 74,868 (54.6%) males and 62,145 (45.4%) females. The most common races were White (50.7%) followed by Hispanic (27.4%) and followed by Blacks (12.7%). With respect to insurance rates, patients were privately insured (48.7%), had Medicaid (46.0%), or were uninsured (5.4%). Median household income ranges were from lowest at $1 to $38,999 (29.6%), low-medium at $39,000 to $47,999 (24.1%), medium-high at $48,000 to $62,999 (23.9%), and highest at $63,000 and more (22.4%). Mortality rates during hospitalization according to insurance status demonstrated the lowest for private insurance (0.75%), followed by uninsured (0.88%), with the highest rate in those with Medicaid (1.30%). Mortality rates during hospitalization according to insurance status demonstrated increasing mortality rates indirectly proportional to income status. Those with the lowest income quartile had a mortality rate of 1.2%, followed by low-medium (1.2%), followed by medium-high (0.9%), and highest (0.7%). On adjusted analysis, the odds ratio for privately insured patients was 1.29 (p = 0.00, 95% CI 1.15 to 1.45), compared to Medicaid patients was 1.93 (p = 0.00, 95% CI 1.48 to 2.51). Separately, on adjusted analysis, the odds ratio for low-medium household income was 0.94 (p = 0.401, 95% CI 0.82 to 1.08), for medium-high household income was 0.76 (p = 0.00, 95% CI 0.65 to 0.87), and highest household income was 0.65 (p = 0.00, 95% CI 0.55 to 0.76).
Conclusion:
Insurance status and MHI have an impact on children undergoing EGS. More studies are necessary to elucidate these disparities.