Black patients at higher risk for delayed diagnosis of appendicitis, increased readmission
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Non-Hispanic Black patients experienced higher rates of delayed appendicitis diagnosis and 30-day, postoperative hospital use compared with their white counterparts, according to research published in JAMA Surgery.
“In acute appendicitis, racial and ethnic disparities occur in presentation, treatment and outcomes. In children, delayed diagnosis may account for higher rates of perforation at presentation,” Ana M. Reyes, MD, MPH, of Northwestern University Feinberg School of Medicine, and colleagues wrote. “However, in adults, less is known about the effects of delayed diagnosis on acute appendicitis outcomes.”
They continued, “There is a literature gap regarding whether Black adults experience higher rates of delayed diagnosis for acute appendicitis compared with white adults and how delays and race and ethnicity are associated with subsequent acute appendicitis outcomes.”
In a population-based, retrospective study, Reyes and colleagues quantified associations between race and ethnicity and delayed diagnosis and postoperative outcomes among 80,312 adult patients (median age, 38 years; 50.8% women) who underwent appendectomy from January 2016 to December 2017. Researchers used data from the Healthcare Cost and Utilization Project’s inpatient and emergency department databases from Florida, Maryland, New York and Wisconsin.
Most patients were privately insured (60.2%) and non-Hispanic white (60.8%), followed by Hispanic (18.8%), non-Hispanic Black (10.9%), other (6.6%) and Asian or Pacific Islander (2.9%).
Results showed 2.5% of patients received a delayed diagnosis, with reportedly higher rates among non-Hispanic Black patients (3.6%) vs. non-Hispanic white patients (2.5%), Hispanic patients (2.4%), other patients (2%) and Asian or Pacific Islander patients (1.5%). Compared with non-Hispanic white patients, non-Hispanic Black patients had a 1.41 (95% CI, 1.21-1.3) times higher adjusted rate for delayed diagnosis.
Patients at hospitals with a greater than 50% Black or Hispanic population had a 0.73 (95% CI, 0.59-0.91) decreased adjusted rate for delayed diagnosis compared with hospitals with less than 25% Black or Hispanic population. Further, patients at hospitals where at least 50% of discharges were Medicaid patients had a 3.51 (95% CI, 1.69-7.28) higher adjusted rate for delayed diagnosis compared with hospitals where less than 10% of discharges were Medicaid patients.
Researchers also reported that delayed diagnosis correlated with a 1.38 (95% CI, 1.36-1.61) increased risk for postoperative 30-day hospital use.
“Delayed diagnosis was associated with increased postoperative 30-day hospital use, suggesting that delayed diagnosis may account for some of the racial and ethnic disparities observed in outcomes after appendicitis,” Reyes and colleagues concluded. “However, it is important to note that outcomes were worse for non-Hispanic Black patients even when diagnosis was not delayed.”
They added: “Further work should focus on the impact of the culturally informed care mechanism for improving diagnostic accuracy as the increased rate of delayed diagnosis observed for non-Hispanic Black patients was mitigated in hospitals that had a more diverse patient population.”
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