Zogg Cheryl K, Scott John W, Jiang Wei, Wolf Lindsey L, Haider Adil H
Yale School of Medicine, New Haven, CT; Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School and the Harvard T.H. Chan School of Public Health, Boston, MA.
Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School and the Harvard T.H. Chan School of Public Health, Boston, MA.
Surgery. 2016 Nov;160(5):1145-1154. doi: 10.1016/j.surg.2016.06.002. Epub 2016 Jul 30.
Differences in perforated appendix admission rates (PAAR) are an ambulatory-sensitive measure of access to care. While pediatric studies report disparities in PAAR, initial adult investigations suggest a lack of racial/ethnic inequity. The objectives of this study were to (1) assess for risk-adjusted, racial/ethnic differences in PAAR among adults on a national scale, (2) consider the extent to which variations (or lack thereof) are explained by age, insurance, and income, and (3) compare results within the United States population to a national segment of the population who are completely insured.
According to the Agency for Healthcare Research and Quality definition of PAAR, adults (aged 18-64 years) in the 2006-2010 Nationwide Inpatient Sample were queried for the occurrence and perforation of acute appendicitis. Risk-adjusted differences were compared by race/ethnicity over 5-year age increments using logistic regression with reweighted estimating equations. Noting disparate outcomes between younger (aged 18-34 years) versus older (aged 35-64 years) adults, age-stratified variations were further considered. Results were compared relative to differences among national military/civilian-dependent patients with universal insurance and were assessed for the extent to which disparities could be explained by variations in insurance and income.
A total of 129,257 (weighted: 638,452) patients were included. Despite a lack of differences overall, significantly worse outcomes among younger (odds ratio point-estimates ranged from 1.11-1.32) and better outcomes among older (0.78-0.93) minority patients were found. This observation contrasted a lack of differences among completely insured military/civilian-dependent patients (n = 12,154). A total of 22.4% (non-Hispanic black versus non-Hispanic white) and 39.0% (Hispanic versus non-Hispanic white) of younger adult differences were explained by insurance-12.2% and 13.6% by income, 29.8% and 44.0% combined.
This national assessment of differences in access to care among adults with acute appendicitis demonstrated the existence of racial/ethnic disparities in PAAR that varied with age and were partially, although incompletely, explained by variations in insurance and income.
穿孔性阑尾炎入院率（PAAR）的差异是衡量医疗可及性的一项对门诊敏感的指标。虽然儿科研究报告了PAAR方面的差异，但最初的成人研究表明不存在种族/民族不平等现象。本研究的目的是：（1）在全国范围内评估成年人群中经风险调整后的PAAR的种族/民族差异；（2）探讨年龄、保险和收入对差异（或无差异情况）的解释程度；（3）将美国人群的结果与完全参保的全国部分人群的结果进行比较。
根据医疗保健研究与质量局对PAAR的定义，对2006 - 2010年全国住院患者样本中的成年人（年龄18 - 64岁）询问急性阑尾炎的发生和穿孔情况。使用带重新加权估计方程的逻辑回归，按种族/民族对5年年龄增量的风险调整差异进行比较。注意到年轻成年人（年龄18 - 34岁）与年长成年人（年龄35 - 64岁）之间的不同结果，进一步考虑按年龄分层的差异。将结果与全国有全民保险的军事/文职家属患者之间的差异进行比较，并评估差异在多大程度上可由保险和收入的差异来解释。
共纳入129,257名（加权后：638,452名）患者。尽管总体上没有差异，但发现年轻少数族裔患者的结果明显更差（优势比点估计范围为1.11 - 1.32），而年长少数族裔患者的结果更好（0.78 - 0.93）。这一观察结果与完全参保的军事/文职家属患者（n = 12,154）之间缺乏差异形成对比。年轻成年人差异中，保险解释了22.4%（非西班牙裔黑人与非西班牙裔白人相比）和39.0%（西班牙裔与非西班牙裔白人相比），收入解释了12.2%和13.6%，保险和收入共同解释了29.8%和44.0%。
这项对急性阑尾炎成年患者医疗可及性差异的全国性评估表明，PAAR存在种族/民族差异，且随年龄而异，尽管保险和收入的差异只能部分（而非完全）解释这些差异。
