The Association Between Timely Access to Pediatric Appendicitis Care and Neighborhood Factors
BACKGROUND: Appendicitis is the most common acute pediatric surgical condition, with 30% of patients presenting as complicated. Complicated appendicitis may indicate a delay in seeking care, resulting in higher complication rates, longer lengths of stay and higher readmission rates compared to simple appendicitis and can serve as indicator for access to care. Although patient-level and neighborhood-level factors can affect timely access to care, the effect of neighborhood factors on access to pediatric surgical care remains poorly understood. We examined the association between neighborhood social determinants of health and the odds of presenting with complicated appendicitis and unplanned post-discharge healthcare utilization. METHODS: A retrospective, cohort study of pediatric patients with appendicitis between 2016-2018 were identified using the Pediatric Health Information System (PHIS) database. Neighborhood characteristics were captured using the Child Opportunity Index (COI), a validated, comprehensive measure of 29 neighborhood characteristics known to impact childrens health. Nationally-normalized COI measurements were divided into quintiles from very low to very high opportunity. Hierarchical logistic regression was used to model the odds of presenting with complicated appendicitis as a function of COI. Adjustments included age, sex, race/ethnicity and insurance. A similar model was assessed for unplanned healthcare utilization, including emergency department visits and readmissions. RESULTS: A total of 67,489 patients had appendicitis with 21,728 (32.2%) being complicated. Patients were 43.3% non-Hispanic white, 60.1% male, 47.8% publicly-insured, and predominantly aged 10-14 years (42.7%). Patients living in very low COI neighborhoods were 34% more likely to present with complicated appendicitis (OR 1.34, 95%CI 1.26, 1.42) compared to those in very high COI neighborhoods. There was no significant association between COI level and unplanned post-discharge healthcare utilization. CONCLUSIONS: Children living in lower COI neighborhoods had an increased risk of presenting with complicated appendicitis; however, neighborhood characteristics were not associated with unplanned healthcare utilization post-discharge. Given increased interest among health systems, public health organizations and third-party payers in mitigating the effects of disadvantaged neighborhood characteristics on health outcomes, these findings may inform policies and programs that seek to improve equitable outcomes in pediatric surgical care.