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CAGS and ACS Evidence Based Reviews in Surgery. Access to emergency operative care: a comparative study between the Canadian and American health care systems.

Question: Do variations of income impact rates of perforation in patients with acute appendicitis? Are variations in appendiceal perforation related to income consistent across these 2 countries? Design: Cohort study using administrative data. Data sources: Canadian Institute for Health Information (CIHI) database (102 692 patients) and the US Nationwide Inpatient Sample (NIS; 276 890 patients). Patient sample: Patients with acute appendicitis diagnosed from 2001 to 2005 were identified using ICD-9 codes. Patients were characterized further by age, sex, insurance status, race and socioeconomic status. Results: In Canada, there was no difference in the odds of perforation among income levels. In the United States, there was a significant, inverse relation between income level and the odds of perforation. The odds of perforation in the lowest income bracket were significantly higher than those in the highest income bracket (odds ratio 1.20, 95% confidence iterval 1.16–1.24). Conclusion: The results suggest that access to emergency operative care is related to socioeconomic status in the United States, but not in Canada. This difference could result from the concern over the ability to pay medical bills or the lack of a stable relationship with a primary care provider that can occur outside of a universal health care system.