男性和女性在髋关节和膝关节置换术使用率上的差异。

Differences between men and women in the rate of use of hip and knee arthroplasty.

作者信息

Hawker G A, Wright J G, Coyte P C, Williams J I, Harvey B, Glazier R, Badley E M

机构信息

Department of Medicine, Faculty of Medicine, University of Toronto, and Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Centre, ON, Canada.

出版信息

N Engl J Med. 2000 Apr 6;342(14):1016-22. doi: 10.1056/NEJM200004063421405.

DOI:10.1056/NEJM200004063421405

PMID:10749964

Abstract

BACKGROUND

Previous studies suggest that, for some conditions, women receive fewer health care interventions than men. We estimated the potential need for arthroplasty and the willingness to undergo the procedure in both men and women and examined whether there were differences between the sexes.

METHODS

All 48,218 persons 55 years of age or older in two areas of Ontario, Canada, were surveyed by mail and telephone to identify those with hip or knee problems. In these subjects, we assessed the severity of arthritis and the presence of coexisting conditions by questionnaire, documented arthritis by examination and radiography, and conducted interviews to evaluate the subjects' willingness to undergo arthroplasty. The potential need for arthroplasty was defined by the presence of severe symptoms and disability, the absence of any absolute contraindications to surgery, and clinical and radiographic evidence of arthritis. The estimates of need were then adjusted for the subjects' willingness to undergo arthroplasty.

RESULTS

The overall response rates were at least 72 percent for the questionnaires and interviews. As compared with men, women had a higher prevalence of arthritis of the hip or knee (age-adjusted odds ratio, 1.76; P<0.001) and had worse symptoms and greater disability, but women were less likely to have undergone arthroplasty (adjusted odds ratio, 0.78; P<0.001). Despite their equal willingness to have the surgery, fewer women than men had discussed the possibility of arthroplasty with a physician (adjusted odds ratio, 0.63). The numbers of people with a potential need for hip or knee arthroplasty were 44.9 per 1000 among women and 20.8 per 1000 among men. After adjustment for willingness to undergo the procedure, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men.

CONCLUSIONS

There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men.

摘要

背景

以往研究表明，在某些情况下，女性接受的医疗保健干预比男性少。我们估计了男性和女性对关节置换术的潜在需求以及接受该手术的意愿，并研究了性别之间是否存在差异。

方法

通过邮件和电话对加拿大安大略省两个地区的所有48218名55岁及以上的人进行了调查，以确定那些有髋部或膝部问题的人。在这些受试者中，我们通过问卷评估关节炎的严重程度和并存疾病的存在情况，通过检查和X光检查记录关节炎情况，并进行访谈以评估受试者接受关节置换术的意愿。关节置换术的潜在需求由严重症状和残疾的存在、手术无任何绝对禁忌症以及关节炎的临床和X光证据来定义。然后根据受试者接受关节置换术的意愿对需求估计值进行调整。

结果

问卷和访谈的总体回复率至少为72%。与男性相比，女性髋部或膝部关节炎的患病率更高（年龄调整优势比为1.76；P<0.001），症状更严重，残疾程度更高，但女性接受关节置换术的可能性较小（调整优势比为0.78；P<0.001）。尽管她们接受手术的意愿相同，但与医生讨论关节置换术可能性的女性比男性少（调整优势比为0.63）。每1000名女性中潜在需要进行髋部或膝部关节置换术的人数为44.9人，男性为20.8人。在调整了接受手术的意愿后，女性每1000人中为5.3人，男性为1.6人。