Health Disparities and Geographic Clusters of Perforated Appendicitis in California Children
Background/Purpose: While geographic disparities in perforated appendicitis have been demonstrated in other states, it is unknown if clusters of pediatric perforated appendicitis exist in California. Understanding where these clusters occur may help improve healthcare quality. We aimed to identify these clusters in California.
Methods: California’s Office of Statewide Health Planning and Development (OSHPD) provided risk adjusted perforated appendicitis rates per 1000 appendicitis cases in patients <18 years in 2015 by county. We utilized ArcGIS Pro 2.1 to geocode these locations and performed a spatial scan to evaluate geographic distribution. We employed a Poisson-based model to identify primary clusters. We used American Community Census 2016 to characterize socio-economic factors. We obtained health professional shortage data from OSHPD to determine primary care access.
Results: In 2015, there were 21,085 cases of pediatric perforated appendicitis in California. Statewide risk adjusted perforated appendicitis rate was 386 per 1000 appendicitis cases. Spatial analysis revealed nine clusters with comparatively high risk adjusted rates of perforated appendicitis (p<0.05) (Figure 1). Four clusters had more than 50% of the surface area characterized as a primary care shortage area. 80% of counties were considered rural or frontier. These clusters demonstrated a median of 17.5% of the population living below the poverty level (13.5-21.6% [interquartile range]). 10% were unemployed (7.9-11.7%) and 52% of the population were of non-white, non-Hispanic background (30.3-66.1%). 6.4% lacked personal transportation (5.3-7.1%).
Conclusion: In 2015, risk adjusted rates for pediatric perforated appendicitis occurred in statistically significant geographic clusters in California. These clusters were largely rural or frontier. Clusters demonstrated high rates of poverty, unemployment, and were largely non-white, non- Hispanic population. Personal transportation was an issue for six percent of the underlying population. Understanding the role of location and social economic factors in this preventable illness is critical to addressing this important pediatric health disparity.