Racial and Ethnic Disparities in the Treatment or Transfer of Pediatric Patients with Appendicitis in Emergency Departments across the US

INTRODUCTION: We aimed to determine if racial and ethnic disparities exist in the decision to treat or transfer pediatric patients with acute appendicitis presenting to US emergency departments (EDs) using a nationally representative sample. METHODS: A retrospective cross-sectional analysis of the 2019 Nationwide Emergency Department Sample (NEDS) was performed. Patients <18 years old with an ICD-10 diagnosis code for acute appendicitis were included. Hospitals were included if ≥1 appendectomy was performed in a patient <18 years old. Our primary outcome was operative treatment at the same facility as presentation, defined as appendectomy or drainage based on ICD-10 and CPT codes. Race/ethnicity was defined as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HL), and Other. Weighted multivariable logistic regression was used to determine the association between race/ethnicity and operative treatment after adjusting for patient and facility characteristics. RESULTS: Of 79,640 weighted ED visits to 638 hospitals, 59,574 (74.8%) pediatric patients with appendicitis underwent operative treatment and 20,066 (25.2%) were discharged or transferred. Patients who received operative treatment were more likely to be NHW (p < 0.001) and have private insurance (p < 0.001). After multivariable adjustment, compared with NHW children, the odds of operative treatment were lower for NHB (adjusted odds ratio [aOR] 0.91, 95% CI 0.88 to 0.94), HL (aOR 0.93, 95% CI 0.94 to 0.96), and Other race (aOR 0.95, 95% CI 0.93 to 0.97) children (Table 1). Table 1. - Odds of Receiving Operative Treatment for Pediatric Appendicitis by Race/Ethnicity Race/ethnicity Weighted rates (95% CI) Unadjusted odds ratio (95% CI) Adjusted odds ratio (95% CI) p Value Non-Hispanic White 77.3% (76.5%–78.1%) Ref. Ref. Ref. Non-Hispanic Black 70.3% (67.4%–73.2%) 0.93 (0.90–0.96) 0.91 (0.88–0.94) <0.001 Hispanic/Latino 71.8% (70.7%–72.9%) 0.94 (0.93–0.96) 0.93 (0.92–0.96) <0.001 Other race/ethnicity 72.6% (70.4%–74.8%) 0.95 (0.93–0.97) 0.95 (0.93–0.97) <0.001 CONCLUSION: Children of minority race/ethnicity with acute appendicitis were significantly less likely to receive operative treatment at the hospital of presentation.