Study: Race, income, insurance associated with delayed appendicitis diagnosis, long hospital stays

Editor's Note

A study led by researchers at Feinberg School of Medicine, Northwestern University in Chicago finds non-Hispanic Black, low income, and publicly insured patients received higher rates of delayed appendicitis diagnoses and long postoperative hospital stays.

The cohort study included 80,312 patients who underwent open or laparoscopic appendectomy in Florida, Maryland, New York, and Wisconsin from 2016 to 2017. Of those, 2.5% of patients received a delayed diagnosis of appendicitis, and 12.1% had postoperative 30-day hospital use after an appendectomy.

Non-Hispanic Black patients were 1.41 times more likely to have delayed diagnosis than non-Hispanic White patients. Patients in lower income brackets, and those with Medicaid or other insurance were also more likely to receive delayed diagnosis (1.32, 1.27 and 1.22 times, respectively).

Delayed diagnosis more often occurred in small hospitals and nonteaching hospitals. Patients at hospitals with greater than 50% Black and Hispanic populations were 0.73 times less likely to have delayed diagnosis compared to hospitals with less than 25% Black and Hispanic populations.

Overall, patients with a delayed diagnosis were 1.38 times more likely to have postoperative 30-day hospital use. This rate was higher for non-Hispanic Black patients (17.5%) than non-Hispanic White patients (11.4%). However, even without a delayed diagnosis, non-Hispanic Black patients were more likely to have long lengths of stay.

These findings indicate that hospitals with fewer resources may provide lower-quality care, discontinuity of care may lead to higher mortality rates, and hospitals with more diverse populations may be better equipped to serve Black patients. The authors conclude, “Further work should focus on the impact of the culturally informed care mechanism for improving diagnostic accuracy."