Bratu Ioana, Martens Patricia J, Leslie William D, Dik Natalia, Chateau Dan, Katz Alan
Department of Pediatric General Surgery, Faculty of Medicine, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
J Pediatr Surg. 2008 Nov;43(11):1964-9. doi: 10.1016/j.jpedsurg.2008.05.013.
BACKGROUND/PURPOSE: Significant socioeconomic disparities have been observed in the rates of perforated appendicitis among children in private health care. We seek to explore if, in the Canadian system of public, universal health care access, pediatric appendicitis rupture rates are an indicator of health disparities.
Using the Population Health Research Data Repository housed at Manitoba Centre for Health Policy, a retrospective analysis over a 20-year period (1983-2003) examined all patients aged less than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes for appendicitis (N = 7475). Multivariate logistic regression analysis was used to calculate odds ratios in the association between appendiceal rupture rates and the patient's socioeconomic status (SES) based upon average household income of the census area adjusted for age, sex, area of residence, and treating hospital.
The overall appendiceal rupture rate was 28.8%. Significant positive predictors of appendiceal rupture were lower rural SES, lower urban SES, younger age, northern area of residence, and receiving treatment at the province's only pediatric tertiary care hospital.
Despite free, universal access health care, children from lower SES areas have increased appendiceal rupture rates. Seeking and accessing medical attention can be complicated by social, behavioral, and geographical problems.
背景/目的：在私立医疗保健机构中，儿童穿孔性阑尾炎的发病率存在显著的社会经济差异。我们试图探讨在加拿大全民免费医疗保健体系中，小儿阑尾炎破裂率是否是健康差异的一个指标。
利用曼尼托巴省卫生政策中心的人口健康研究数据存储库，对20年期间（1983 - 2003年）所有年龄小于18岁、具有国际疾病分类第九版临床修订本阑尾炎诊断和手术编码的患者进行回顾性分析（N = 7475）。基于按年龄、性别、居住地区和治疗医院调整后的普查区域平均家庭收入，采用多因素逻辑回归分析计算阑尾破裂率与患者社会经济地位（SES）之间关联的优势比。
阑尾破裂的总体发生率为28.8%。阑尾破裂的显著正向预测因素为农村SES较低、城市SES较低、年龄较小、居住在北部地区以及在该省唯一的儿科三级护理医院接受治疗。
尽管有免费的全民医疗保健，但来自社会经济地位较低地区的儿童阑尾破裂率更高。寻求和获得医疗护理可能因社会、行为和地理问题而变得复杂。
