Social determinants of health in pediatric appendicitis: a systematic review and meta-analysis

Introduction: This study aimed to evaluate the social determinants of health in appendicitis among the pediatric population. Methods: Systematic review and meta-analysis. Results: Forty-three studies met the eligibility criteria. There was a male predominance (55-64%) and a mean age of 10–12 years. The complicated appendicitis rate ranged from 3.3 to 46.9%. Black (risk difference [RD]: 0.00; 95% confidence interval [CI]: −0.11 to 0.11) and Hispanic (RD: 0.02; 95% CI: −0.05 to 0.09) individuals had no significant difference in complicated appendicitis rates compared to White individuals, while Asian individuals had a higher rate (RD: 0.05; 95% CI: 0.02-0.08). No significant racial differences were observed when accessing laparoscopy. Complicated appendicitis rates were similar between sexes (RD: −0.00; 95% CI: −0.01 to 0.00), but females had a higher likelihood of undergoing laparoscopy than males (RD: 0.03; 95% CI: 0.01-0.05). Patients in public hospitals had a higher rate of complicated appendicitis than those in private hospitals (RD: 0.07; 95% CI: 0.04-0.09). General hospitals had lower rates than pediatric or teaching hospitals (RD: −0.06; 95% CI: −0.12 to −0.00). Patients from rural and urban areas had similar complicated appendicitis rates (RD: −0.01; 95% CI: −0.03 to 0.01). Lower education was not associated with a higher risk of complicated appendicitis (RD: 0.02; 95% CI: −0.00 to 0.04). However, lower socioeconomic status was linked to an increased risk (RD: 0.02; 95% CI: 0.00-0.04). Conclusions: Social determinants of health influence the outcomes of pediatric appendicitis. These findings underscore the potential for targeted interventions to improve health care equity in pediatric appendicitis management.