Ruptured appendicitis among children as an indicator of access to care

Objective. To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously b een described (Braveman, Schaaf, Egerter, et al. 1994). Data Sources/Study Setting. State of Maryland Medicaid claims data for chil dren less than or equal to 18 years of age from 1989 to 1993 and hospital d ischarge data for children less than or equal to 19 years of age from 1989 to 1994 were analyzed. Study Design. Administrative data analysis pre- and post-implementation of a Medicaid managed care program called Maryland Access to Care. Data Collection/Extraction Methods. Medicaid claims and hospital discharge ICD-9-CM codes were used to define hospitalization for ruptured and nonrupt ured appendicitis. Linear regression was used to model trends. Logistic reg ression was used to model the probability of ruptured appendicitis. Principal Findings. Among the 374 Medicaid inpatient claims for appendiciti s, 37 percent were for ruptured appendicitis. Among the 5,141 hospital disc harges for appendicitis, 30 percent were for ruptured appendicitis. Using M edicaid claims data, the probability of ruptured appendicitis was inversely related to age (OR = 0.86, 95% CI 0.81-0.91), white race (OR = 0.35, 95% C I 0.17-0.71) and preventive care visits (OR = 0.19, 95% CI 0.05-0.77). Usin g hospital discharge data, age (OR = 0.91, 95% CI 0.90-0.93) and female gen der (OR = 0.87, 95% CI 0.77-0.99) were significant covariates. Insurance-re lated covariates were not significant in multivariate models addressing the probability of ruptured appendicitis. Conclusions. During a period of rapid managed care growth, insurance type w as not associated with an increased risk of ruptured appendicitis among chi ldren in this geographic area. Age, female gender, and the number of preven tive care visits are inversely related to the risk of ruptured appendix amo ng children. The protective effect of preventive care visits suggests that a primary care relationship facilitates access to care, thus reducing delay in the management of appendicitis.