Spatial–temporal clusters of pediatric perforated appendicitis in California

• Published in: Journal of pediatric surgery Vol. 56; no. 6; pp. 1208 - 1213
• Main Authors: Schwartz, Kristy, Nguyen, Margaret
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021
• Subjects: Geographic disparity; GIS; Health disparities; Pediatric perforated appendicitis; Spatial–temporal analysis; GIS; Spatial–temporal analysis; Geographic disparity; Pediatric perforated appendicitis; Health disparities
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2021.02.031

Perforated appendicitis is a well-documented child health disparity. Geographic patterns in perforated appendicitis exist in several United States regions, but such patterns have not been described in California. We aimed to analyze spatial–temporal patterns of pediatric perforated appendicitis and identify population characteristics contributing to these cluster patterns. We geocoded risk-adjusted perforated appendicitis rates per 1000 appendicitis cases in patients 1–17 years from 2005–2015 in California. We performed a space-time cube analysis to identify hot spot trends. We performed logistic regression to estimate rural classification associated with spatial–temporal hot spots and multivariate analysis to assess effects of socioeconomic factors. In 2005–2015, 43,888 cases of pediatric perforated appendicitis occurred in California. Median risk-adjusted perforated appendicitis rate was 312 per 1000 appendicitis cases. We identified 11 spatial–temporal hot spots of perforated appendicitis. Rural micropolitan counties had 14 times higher odds of being classified as a hot spot (p<0.05, 95% CI 1–185). Poverty was a significant predictor of high perforated appendicitis median risk-adjusted rate (p<0.004). We identified 11 California hot spots of perforated appendicitis that persisted across a ten-year time span. Incorporating geography alongside our understanding of socioeconomic factors is a critical step in addressing this important child health disparity.