Disparities in appendicitis rupture rate among mentally ill patients

Using the National Health Insurance (NHI) hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix.After adjusting for age, gender, ethnicity, socioeconomic status (SES) and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20–3.64). However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77–1.73) or other mental disorders (OR, 1.58; 95% CI: 0.89–2.81) was not a significant predictor for a ruptured appendix.These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.Acute appendicitis is a common surgical emergency. A growing inventory of medical literature has used differential rates of ruptured appendix as an indicator of a potential barrier to the accessibility of medical care [1-7]. Although symptomatic acute appendicitis is not preventable, timely treatment of symptomatic acute appendicitis can help to prevent appendiceal perforation, which is associated with severe morbidity and elevated mortality[1,8-10]. According to previous literature, the strongest predictor of perforation is postponed surgery in excess of 12 to 24 hours after the symptoms of appendicitis first occured. Previous reports observed higher rates of appendiceal perforation among people without insurance, minorities, young children, the elderly and men [1-3,7,8,11