TY - JOUR
T1 - Differential access to care
T2 - The role of age, insurance, and income on race/ethnicity-related disparities in adult perforated appendix admission rates
AU - Zogg, Cheryl K.
AU - Scott, John W.
AU - Jiang, Wei
AU - Wolf, Lindsey L.
AU - Haider, Adil H.
N1 - Funding Information:
The Center for Surgery and Public Health is jointly supported in part with the Uniformed Services University of the Health Sciences by a grant from the Henry M. Jackson Foundation for the advancement of military medicine to provide protected research efforts involving the analysis and study of TRICARE data. WJ and AHH received partial salary support. AHH is the Primary Investigator of the joint study; he also serves on the Institute of Medicine's Military Trauma Care's Learning Health System and its Translation to the Civilian Sector Committee. AHH is the cofounder and an equity holder in Patient Doctor Technologies Inc, which owns and operates http://www.doctella.com .
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Differences in perforated appendix admission rates (PAAR) are an ambulatory-sensitive measure of access to care. While pediatric studies report disparities in PAAR, initial adult investigations suggest a lack of racial/ethnic inequity. The objectives of this study were to (1) assess for risk-adjusted, racial/ethnic differences in PAAR among adults on a national scale, (2) consider the extent to which variations (or lack thereof) are explained by age, insurance, and income, and (3) compare results within the United States population to a national segment of the population who are completely insured. Methods According to the Agency for Healthcare Research and Quality definition of PAAR, adults (aged 18-64 years) in the 2006–2010 Nationwide Inpatient Sample were queried for the occurrence and perforation of acute appendicitis. Risk-adjusted differences were compared by race/ethnicity over 5-year age increments using logistic regression with reweighted estimating equations. Noting disparate outcomes between younger (aged 18-34 years) versus older (aged 35-64 years) adults, age-stratified variations were further considered. Results were compared relative to differences among national military/civilian-dependent patients with universal insurance and were assessed for the extent to which disparities could be explained by variations in insurance and income. Results A total of 129,257 (weighted: 638,452) patients were included. Despite a lack of differences overall, significantly worse outcomes among younger (odds ratio point-estimates ranged from 1.11–1.32) and better outcomes among older (0.78–0.93) minority patients were found. This observation contrasted a lack of differences among completely insured military/civilian-dependent patients (n = 12,154). A total of 22.4% (non-Hispanic black versus non-Hispanic white) and 39.0% (Hispanic versus non-Hispanic white) of younger adult differences were explained by insurance—12.2% and 13.6% by income, 29.8% and 44.0% combined. Conclusion This national assessment of differences in access to care among adults with acute appendicitis demonstrated the existence of racial/ethnic disparities in PAAR that varied with age and were partially, although incompletely, explained by variations in insurance and income.
AB - Background Differences in perforated appendix admission rates (PAAR) are an ambulatory-sensitive measure of access to care. While pediatric studies report disparities in PAAR, initial adult investigations suggest a lack of racial/ethnic inequity. The objectives of this study were to (1) assess for risk-adjusted, racial/ethnic differences in PAAR among adults on a national scale, (2) consider the extent to which variations (or lack thereof) are explained by age, insurance, and income, and (3) compare results within the United States population to a national segment of the population who are completely insured. Methods According to the Agency for Healthcare Research and Quality definition of PAAR, adults (aged 18-64 years) in the 2006–2010 Nationwide Inpatient Sample were queried for the occurrence and perforation of acute appendicitis. Risk-adjusted differences were compared by race/ethnicity over 5-year age increments using logistic regression with reweighted estimating equations. Noting disparate outcomes between younger (aged 18-34 years) versus older (aged 35-64 years) adults, age-stratified variations were further considered. Results were compared relative to differences among national military/civilian-dependent patients with universal insurance and were assessed for the extent to which disparities could be explained by variations in insurance and income. Results A total of 129,257 (weighted: 638,452) patients were included. Despite a lack of differences overall, significantly worse outcomes among younger (odds ratio point-estimates ranged from 1.11–1.32) and better outcomes among older (0.78–0.93) minority patients were found. This observation contrasted a lack of differences among completely insured military/civilian-dependent patients (n = 12,154). A total of 22.4% (non-Hispanic black versus non-Hispanic white) and 39.0% (Hispanic versus non-Hispanic white) of younger adult differences were explained by insurance—12.2% and 13.6% by income, 29.8% and 44.0% combined. Conclusion This national assessment of differences in access to care among adults with acute appendicitis demonstrated the existence of racial/ethnic disparities in PAAR that varied with age and were partially, although incompletely, explained by variations in insurance and income.
UR - http://www.scopus.com/inward/record.url?scp=84994894822&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2016.06.002
DO - 10.1016/j.surg.2016.06.002
M3 - Article
C2 - 27486003
AN - SCOPUS:84994894822
SN - 0039-6060
VL - 160
SP - 1145
EP - 1154
JO - Surgery
JF - Surgery
IS - 5
ER -