Geographic disparities in the risk of perforated appendicitis among children in Ohio: 2001每2003

作者：Robert B Penfold; Deena J Chisolm; Benedict C Nwomeh; Kelly J Kelleher

来源：International Journal of Health Geographics, 2008.

DOI：10.1186/1476-072x-7-56

Controlling for age, sex, insurance type, comorbid conditions, socioeconomic status, appendectomy rates, hospital type, and hospital location, we found that patient residence in a rural ZIP code with significant levels of commuting to metropolitan areas was associated with higher risk of perforation compared to residence in rural areas with commuting to smaller urban clusters. The former group was more likely to seek care in an urbanized area, and was more likely to receive care in a Children%26apos;s Hospital.To our knowledge, this is the first study to differentiate rural dwellers with respect to outcomes associated with appendicitis as opposed to simply comparing %26quot;rural%26quot; to %26quot;urban%26quot;. Risk of perforated appendicitis associated with commuting patterns is larger than that posed by several individual indicators including some age-sex cohort effects. Future studies linking the activity spaces of rural dwellers to individual patterns of seeking care will further our understanding of perforated appendicitis and ambulatory care sensitive conditions in general.Appendectomy for appendicitis is one of the most frequent surgical procedures performed in the United States [1,2]. Children are at the highest risk of perforation and perforated appendicitis is associated with $1.5 billion in annual healthcare charges [1]. On average, 35 percent of appendicitis cases are %26quot;ruptured%26quot; or %26quot;perforated%26quot; prior to surgery, increasing both cost and risk of poor surgical outcome [3].Perforated appendicitis is considered an ambulatory care sensitive condition (ACSC) that can be prevented with timely and appropriate care [4]. It has been used as a measure of access to preventative care [5]. The Agency for Healthcare Research and Quality has called for research regarding the relationship between geographic factors and hospital admission for ambulatory care sensitive conditions at the ZIP code level [4]. To date, such research has primarily focused on rural-urban comparisons and not sufficiently examine