Surgeons perform an appendectomy, or the removal of the appendix. A new study suggests children from lower-resourced neighborhoods see delays in care for appendicitis. File photo by Jeremy Hall/UPI | License Photo
Feb. 16 (UPI) -- Children living in neighborhoods with lower-quality schools and housing, high crime, and limited economic opportunities are more likely to develop complicated appendicitis, a study published Wednesday by JAMA Network Open found.
People age 18 years and younger with appendicitis living in neighborhoods with lower scores on the Child Opportunity Index had a 28% higher risk for the more severe form of the common condition compared to children from wealthier areas, the data showed.
This indicates they may be experiencing delays in diagnosis and access to care, the researchers said.
"Timely access to pediatric surgical care may help reduce the need for emergency surgery, long hospital stays or admission to the intensive care unit," study co-author Dr. Fizan Abdullah said in a press release.
"Our findings may help in developing policies and programs to increase community opportunity and ensure that all children, no matter where they live, gain equitable access to surgical care," said Abdullah, head of pediatric surgery at Lurie Children's Hospital in Chicago.
The findings are based on an analysis of nearly 67,500 children diagnosed with appendicitis nationally between Oct. 1, 2015, and Sept. 30, 2018.
More than 31,000, or 46%, of the included appendicitis cases were "complicated," and 48% of the patients in the study were on Medicaid or other forms of public insurance for those living in poverty, the researchers said.
About 300,000 children and adults in the United States each year undergo surgical removal of the appendix, or appendectomy, the Centers for Disease Control and Prevention estimates.
Appendicitis is a painful condition caused by inflammation of the appendix, a thin pouch that protrudes from the colon on the lower right side of the abdomen, according to the Mayo Clinic.
About 70% of children with appendicitis have what is called acute, uncomplicated appendicitis, which can be treated with antibiotics, in many cases, though, surgical removal of the unnecessary organ may be necessary, recent research suggests.
The remaining cases of the condition involve complicated appendicitis, which occurs when the pouch develops a small hole due to the accumulation of fluid and becomes infected, studies indicate.
If left untreated, the hole in the appendix can cause the fluid to leak into the abdominal cavity, meaning potentially harmful bacteria can spread to other organs, leading to potentially severe health complications, including peritonitis, Abdullah and his colleagues said.
Peritonitis is an infection of the abdominal wall that can cause liver and kidney damage, among other problems.
Complicated appendicitis has also been linked to higher surgical complication rates and longer hospital stays, compared with simple appendicitis, the researchers said.
Developed by diversitydatakids.org, the Child Opportunity Index measures neighborhood resources and conditions that matter for a child's healthy development.
It is designed to compare the level of opportunity that neighborhoods provide for children across the United States in a single metric, based on 29 factors, including access and quality of early childhood education, availability of green space, access to healthy food and pollution levels.
Children from neighborhoods with lower scores on the Child Opportunity Index had a higher risk for complicated appendicitis compared with those from higher-scoring areas, the researchers said.
However, there were no differences between neighborhood opportunity levels and the odds of unplanned post-discharge healthcare use following appendicitis treatment, the data showed.
"[This] suggests that once patients have established care, they are connected to a pediatric resource," study co-author Dr. Megan Bouchard said in a press release.
These resources "can support families after discharge, regardless of the patient's neighborhood," said Bouchard, a fourth-year surgical resident at Georgetown University Hospital in Washington, D.C.