Appendicitis Often Spotted Later in Black Patients, Ages 18-64

While appendicitis is a typical emergency, Black people experiencing its symptoms more often have a delayed diagnosis.

But that doesn’t happen in lower-quality hospitals that serve more Black patients, according to new research. There, Black people are diagnosed more quickly.

“There is a benefit to patients being treated in predominantly minority-serving hospitals when they are having symptoms of appendicitis,” said senior author Dr. Anne Stey. She is a surgeon and assistant professor of surgery at Northwestern University Feinberg School of Medicine in Chicago.

Symptoms of appendicitis include sudden pain that begins on the right side of the lower abdomen; pain that worsens if you cough, walk, or make other jarring movements; nausea and vomiting; and loss of appetite.

A delayed diagnosis is linked to complications requiring more extended hospital stays and increased return to the hospital within 30 days after the appendix is removed.

The new study included data from over 80,000 patients aged 18 to 64. They had appendectomies in 2016 or 2017 in Florida, Maryland, New York, and Wisconsin.

The researchers found that diagnosis delays were less common in hospitals serving populations that were greater than 50% Black or Hispanic people compared to those where they represented less than 25%.

Nearly half of the patients in the study who initially had a delayed diagnosis were eventually diagnosed and had surgery at a different hospital.

“It may be hospitals that are more used to serving racial-ethnic minority patients are better at diagnosing them because they’re more culturally informed and have a better understanding of these patients,” Stey said in a Northwestern news release.

The researchers concluded that racially integrating hospitals would provide better clinical care and a more sustainable healthcare system.

Hospitals with more uninsured or publicly insured patients receive lower reimbursements. Minorities are more often in these lower-reimbursement groups, the study authors noted.

“The lower reimbursements to hospitals serving Medicaid patients create an unsustainable system,” Stey said. “We have a two-tiered health system. By racially integrating hospitals, our health care system would be able to provide better clinical care to all patients, but also create a more sustainable health care system.”

More than 250,000 Americans a year are diagnosed with appendicitis. Delays can lead to a perforated or ruptured appendix. This leads to more infections after surgery and other complications.

The researchers plan to investigate the cost implications of delayed diagnosis.

The new study was published Jan. 18 in JAMA Surgery.

The research was funded by the American College of Surgeons and the U.S. National Heart, Lung, and Blood Institute of the National Institutes of Health.

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