因患关节炎而接受髋关节置换手术的患者中，西班牙裔患者的比例相对较低，这与医疗保健可及性和社会经济地位无关。

Recipients of hip replacement for arthritis are less likely to be Hispanic, independent of access to health care and socioeconomic status.

作者信息

Escalante A, Espinosa-Morales R, del Rincón I, Arroyo R A, Older S A

机构信息

The University of Texas Health Science Center at San Antonio, 78284, USA.

出版信息

Arthritis Rheum. 2000 Feb;43(2):390-9. doi: 10.1002/1529-0131(200002)43:2<390::AID-ANR20>3.0.CO;2-R.

DOI:10.1002/1529-0131(200002)43:2<390::AID-ANR20>3.0.CO;2-R

PMID:10693880

Abstract

OBJECTIVE

To compare the proportion of Hispanics among recipients of hip replacements for primary articular disorders, recipients of knee replacements for the same reason, and persons hospitalized for other reasons.

METHODS

Twelve of the 17 accredited hospitals in Bexar County, Texas, in which hip or knee replacement surgery is performed permitted us to review their medical records. From 1993 through 1995, 3,100 elective, non-fracture-related, hip or knee replacements were performed. These individuals were matched by age, sex, hospital, and month of admission with 4,604 persons hospitalized for other reasons. Age, sex, ethnic background, type of medical insurance, median household income by zip code of residence, joint replaced, and surgical diagnosis were abstracted from the medical records. The validity of variables abstracted from the medical records was tested by comparison with self-report data in 115 patients interviewed prior to elective hip or knee replacement surgery.

RESULTS

During the study period, 2,275 subjects had a total knee replacement and 825 had a total hip replacement. Recipients of hip replacements were significantly less likely to be Hispanic than were recipients of knee replacements (19.5% versus 29.9%; odds ratio [OR] 0.57, 95% confidence interval [95% CI] 0.46-0.71; P < or = 0.001) or persons hospitalized for other reasons (29.4% Hispanic; OR 0.67, 95% CI 0.55-0.81). The under-representation of Hispanics was more pronounced among persons undergoing hip replacement for osteoarthritis compared with recipients of knee replacements for the same disease (OR 0.48, 95% CI 0.37-0.62). This pattern persisted after adjusting for age, sex, type of medical insurance, and median household income by the zip code of residence. Concordance between medical records and self-report data on ethnic background was high (kappa = 0.93).

CONCLUSION

Recipients of hip replacement are less likely to be Hispanic than are other hospitalized persons with a similar level of access to care. The reasons for this under-representation probably involve factors in addition to lack of access to health care and low socioeconomic status. Further research is needed to understand the nature of such factors.

摘要

目的

比较因原发性关节疾病接受髋关节置换术的患者、因相同原因接受膝关节置换术的患者以及因其他原因住院的患者中西班牙裔的比例。

方法

得克萨斯州贝克斯县17家认可医院中有12家进行髋关节或膝关节置换手术，这些医院允许我们查阅其病历。1993年至1995年期间，共进行了3100例择期、非骨折相关的髋关节或膝关节置换手术。将这些患者按年龄、性别、医院和入院月份与4604名因其他原因住院的患者进行匹配。从病历中提取年龄、性别、种族背景、医疗保险类型、居住邮政编码对应的家庭收入中位数、置换关节及手术诊断等信息。通过与115例择期髋关节或膝关节置换手术前接受访谈患者的自我报告数据进行比较，检验从病历中提取变量的有效性。

结果

在研究期间，2275名受试者接受了全膝关节置换术，825名接受了全髋关节置换术。髋关节置换术患者中西班牙裔的比例显著低于膝关节置换术患者（19.5%对29.9%；优势比[OR]0.57，95%置信区间[95%CI]0.46 - 0.71；P≤0.001）或因其他原因住院的患者（西班牙裔占29.4%；OR 0.67，95%CI 0.55 - 0.81）。与因相同疾病接受膝关节置换术的患者相比，因骨关节炎接受髋关节置换术的患者中西班牙裔的比例更低（OR 0.48，95%CI 0.37 - 0.62）。在对年龄、性别、医疗保险类型和居住邮政编码对应的家庭收入中位数进行调整后，这种模式仍然存在。病历与自我报告的种族背景数据之间的一致性很高（kappa = 0.93）。