Racial Disparities in the Management of Pediatric Appenciditis Evan R. Kokoska, M.D.,* ,1 T. M. Bird, M.S.,† James M. Robbins, Ph.D.,† Samuel D. Smith, M.D.,* John M. Corsi, M.B.A.,* and Brendan T. Campbell, M.D., M.P.H.* *Department of Surgery, †Pediatrics, Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences, Little Rock, Arkansas Submitted for publication January 10, 2006 Background. Our objective was to compare the ra- cial differences in incidence and management of pedi- atric appendicitis. Materials and methods. Data for this study come from two large national hospital discharge databases from the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project: The Nation- wide Inpatient Sample (NIS) and the Kids’ Inpatient Database (KID). Analysis was restricted to age less than 18 years with an ICD-9 diagnosis of either simple (540.9) or complex (540.0 and 540.1) appendicitis. Data were weighted to represent national estimates. Inci- dence was defined as the number of new disease cases divided by the number of at risk hospitalized children. Results. The data for this study contained an esti- mated 428,463 [95% confidence interval (CI)  414, 672- 442, 253] cases of appendicitis, representing approxi- mately 65,000 to 75,000 cases annually. Multi-variant analysis suggests that African-Americans, as com- pared to Caucasians, were less prone to develop ap- pendicitis [odds ratio (OR)  0.39, 95% CI (0.38, 0.41)], but less frequently underwent laparoscopic treatment [OR  0.78, 95% CI (0.74, 0.87)], and were more likely to have complex appendicitis [OR  1.39, 95% CI (1.30, 1.49)]. In contrast, Hispanics were more likely than Caucasians to both develop appendicitis [OR  1.48, 95% CI (1.41, 1.56)] and to have complex disease [OR  1.10, 95% CI (1.05, 1.16)]. The incidence of appendicitis was less frequent in females versus males [OR  0.69, 95% CI (0.68, 0.70)] but the likelihood of laparoscopic exploration was higher [OR  1.39, 95% CI (1.34, 1.43)]. Finally, children with public insurance [OR  1.25, 95% CI (1.21, 1.29)] and uninsured children [OR  1.10, 95% CI (1.04, 1.16)] were more likely to have complex appendicitis when compared to children with private insurance. Conclusions. African-American children with appen- dicitis have lower overall hospitalization rates, higher rates of perforation, a greater delay to surgical man- agement, and lower laparoscopic rates. In contrast, Hispanic children more frequently had appendicitis and complex disease. The treatment of African-Amer- ican and Hispanic children overall was associated with a longer hospital stay and higher charges. The lower incidence of appendicitis in African-American children is incompletely understood and the disparity in surgical management among minority children re- mains troubling. © 2007 Elsevier Inc. All rights reserved. Key Words: pediatric appendicitis; racial variation; perforation rates. INTRODUCTION Acute appendicitis was a relatively uncommon con- dition until the late 19th century at which time there was a significant increase in frequency, especially in developed countries such as the United Kingdom and the United States [1]. Currently, acute appendicitis is the most common condition in the abdomen requiring operation. The lifetime risk of appendicitis is approxi- mately 8.6% in males and 6.7% in females [2]. The objective of this study was to compare the racial differ- ences with regard to both the incidence and manage- ment of pediatric appendicitis. To our knowledge, all similar studies to date have either been much smaller in scope, have not been pediatric specific, or did not address racial differences in the United States. MATERIALS AND METHODS The current study was approved by the Institutional Review Board at University of Arkansas for Medical Sciences (#28858). Data 1 To whom correspondence and reprint requests should be ad- dressed at Arkansas Children’s Hospital #837, Little Rock, AR 72202. E-mail: kokoskaevanr@uams.edu. Journal of Surgical Research 137, 83– 88 (2007) doi:10.1016/j.jss.2006.06.020 83 0022-4804/07 $32.00 © 2007 Elsevier Inc. All rights reserved.