Effect of Race and Socioeconomic Status in the Treatment of Appendicitis in Patients With Equal Health Care Access

BACKGROUND: Lower socioeconomic and minority racial/ethnic status have been linked to delays in surgical care and thus higher appendiceal perforation rates. HYPOTHESIS: Equal access to health care eliminates the previously reported socioeconomic and racial/ethnic disparities in rates of appendiceal perforation. DESIGN: Retrospective cohort study using discharge abstract data and US census data. SETTING: Twelve regional Kaiser Permanente hospitals in southern California. PATIENTS: A total of 16,156 patients treated for appendicitis. Patients were divided into low, medium, and high groups based on annual household income and educational level, as well as racial/ethnic status (white, black, Hispanic, and Asian). MAIN OUTCOME MEASURES: Appendiceal perforation (AP) rate and length of hospitalization (LOH). RESULTS: The adjusted odds ratio for AP was lower in Hispanics and similar in blacks and Asians compared with whites. The odds ratio for AP was similar in high- and medium-income families compared with low-income families. The odds ratio for AP was higher in patients with high educational levels and similar in those with medium educational levels compared with low educational levels. The adjusted LOH was longer in blacks, shorter in Hispanics, and similar in Asians compared with whites. The LOH was similar in high- and medium-income families compared with low-income families. The LOH was higher in patients with medium educational levels and similar in those with high educational levels compared with low educational levels. CONCLUSIONS: Lower socioeconomic background and minority race/ethnicity did not correlate with higher AP rates or a clinically longer LOH in patients with equal access to care. Based on these findings, we believe that equal health care access leads to equivalent outcomes in all patients with appendicitis.