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Open Access Highly Accessed Research article

Disparities in appendicitis rupture rate among mentally ill patients

Jen-Huoy Tsay1, Cheng-Hua Lee23, Yea-Jen Hsu4, Pen-Jen Wang3, Ya-Mei Bai5, Yiing-Jenq Chou6 and Nicole Huang6*

Author Affiliations

1 Department of Social Work, College of Social Science, National Taiwan University, Taipei, Taiwan, R.O.C

2 Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming University, Taipei, Taiwan, R.O.C

3 Bureau of National Health Insurance, Taipei, Taiwan, R.O.C

4 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

5 Psychiatry Department, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C

6 Institute of Public Health, School of Medicine, National Yang Ming University, 155 Li-Nong Street, Section 2, Taipei 112, Taiwan, R.O.C

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BMC Public Health 2007, 7:331  doi:10.1186/1471-2458-7-331

Published: 15 November 2007



Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness.


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.