Non-Hispanic Black adults more likely to have delayed appendicitis diagnosis

Non-Hispanic Black adults had higher rates of delayed appendicitis diagnoses in the ED compared with white adults, putting them at greater risk for perforated appendicitis and post-surgery infection, a recent study found.

According to Ana M. Reyes, MD, MPH, a general surgery resident at Jackson Memorial Hospital in Miami, and colleagues, prior research has shown that non-Hispanic Black children were more likely to have a delayed or missed appendicitis diagnosis, were less likely to undergo imaging and more likely to have perforated appendicitis compared with non-Hispanic white children.

“However, in adults, less is known about the effects of delayed diagnosis on acute appendicitis outcomes,” the researchers wrote in JAMA Surgery. “Additionally, to our knowledge, no study has documented rates of delayed diagnosis of acute appendicitis in adults at the population level.”

Reyes and colleagues analyzed data from 80,312 patients who had undergone appendectomies from January 2016 to December 2017 in four states to investigate associations between race, ethnicity and acute appendicitis diagnoses and outcomes. The data were drawn from the Agency of Healthcare Research and Quality’s Healthcare Cost and Utilization Project state inpatient databases, as well as from state emergency department databases.

Of the total study group, 24.8% of participants were aged 25 to 34 years, and 50.8% were women. Non-Hispanic white adults made up 60.8% of participants, while non-Hispanic Black adults made up 10.9%.

Reyes and colleagues found that 2.5% of patients experienced appendicitis delays. Compared with white patients, non-Hispanic Black patients were 1.41 (95% CI, 1.21-1.63) times more likely to have a delayed diagnosis.

Delayed diagnoses also contributed to worse patient outcomes, according to the researchers. Patients who experienced delays were 1.38 (95% CI, 1.23-1.56) times likelier to have postoperative 30-day hospital use compared with patients who did not have a delayed diagnosis.

“Even after controlling for delayed diagnosis, non-Hispanic Blacks were 1.22 times more likely to have postoperative 30-day hospital use than non-Hispanic white patients,” the researchers wrote.

The results further showed that patients with Medicaid were 1.27 (95% CI, 1.14-1.43) more likely to have a delayed diagnosis than patients with private insurance. In hospitals where Medicaid patients accounted for more than 50% of discharges, there was a 3.51 (95% CI, 1.69-7.28) higher likelihood of having a delayed diagnosis — a result that “provides support for findings that safety-net hospitals have fewer resources and may provide lower-quality health care than hospitals with a larger private payer population,” Reyes and colleagues wrote.

Notably, patients at hospitals with a more than 50% Hispanic or non-Hispanic Black population had a 0.73 (95% CI, 0.59-0.91) lower adjusted rate of delayed diagnosis compared with hospitals that had a less than 25% Hispanic or non-Hispanic Black population. The researchers reasoned that this finding may be the effect of better cultural understanding in hospitals that primarily serve underrepresented populations, “especially those who disproportionately experience worse outcomes.”

“If better care is achieved for minority patients through a diverse workforce as well as a diverse patient population, further work must be done to increase the diversity of the medical workforce as well as enhancing clinician education about cultural competence and antiracism,” they wrote. “Finally, policy makers must work to ensure parity in reimbursement for care provided in hospitals with diverse patient populations.”

References:

• Delayed appendicitis diagnosis more common among non-Hispanic Black adults. https://www.eurekalert.org/news-releases/976682. Published Jan. 18, 2023. Accessed Jan. 18, 2023.
• Reyes A, et al. JAMA Surg. 2023;doi:10.1001/jamasurg.2022.7055.