Escalante Agustín, Barrett Jane, del Rincón Inmaculada, Cornell John E, Phillips Charlotte B, Katz Jeffrey N
Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Texas Health Science Center at San Antonio, 78229, USA.
Med Care. 2002 Jun;40(6):451-60. doi: 10.1097/00005650-200206000-00002.
To compare the utilization of total hip replacement (THR) between Hispanic persons and non-Hispanic persons in a sample with health insurance.
Case-control study using Medicare claims data.
The cases were Medicare beneficiaries from Arizona, Illinois, New Mexico, or Texas who underwent a primary THR. The controls were Medicare beneficiaries who did not receive a THR, matched by age, sex, and county of residence.
Beneficiary surnames and the race indicator in Medicare records were used to classify beneficiaries' probability of being Hispanic. Conditional logistic regression was used to estimate the odds of receiving of THR, adjusting for Medicaid eligibility.
Six thousand four hundred thirty-seven recipients of a primary THR were matched to 12,874 controls. According to the Medicare race indicator, 1% of recipients of THR and 3.3% of controls were Hispanic (P < or =0.001). The odds of THR decreased as the probability of Hispanic ethnicity increased, from an odds ratio (OR) of 1.00 among beneficiaries with non-Hispanic surnames, to an OR of 0.36 among those with heavily Hispanic surnames (95% CI, 0.31, 0.43). Poverty, as reflected by eligibility for Medicaid, did not modify the low odds of THR among Hispanic persons (OR, 0.25 among Medicaid-eligible Hispanic persons; 95% CI, 0.19, 0.33; and OR, 0.30 among Hispanic persons not Medicaid eligible; 95% CI, 0.24, 0.38).
Hispanic persons with Medicare receive THR at lower rates than do non-Hispanic persons. Because Medicare covers THR, our findings suggest that under utilization of THR by Hispanic persons cannot be attributed to lack of health insurance alone.
比较有医疗保险的样本中西班牙裔人群与非西班牙裔人群全髋关节置换术（THR）的使用情况。
使用医疗保险理赔数据的病例对照研究。
病例为来自亚利桑那州、伊利诺伊州、新墨西哥州或得克萨斯州接受初次全髋关节置换术的医疗保险受益人。对照为未接受全髋关节置换术的医疗保险受益人，按年龄、性别和居住县进行匹配。
医疗保险记录中的受益人姓氏和种族指标用于分类受益人是西班牙裔的概率。使用条件逻辑回归估计接受全髋关节置换术的几率，并对医疗补助资格进行调整。
6437例初次全髋关节置换术接受者与12874例对照进行了匹配。根据医疗保险种族指标，全髋关节置换术接受者中有1%为西班牙裔，对照中有3.3%为西班牙裔（P≤0.001）。随着西班牙裔种族概率的增加，全髋关节置换术的几率降低，从非西班牙裔姓氏受益人中的优势比（OR）1.00，降至西班牙裔姓氏占主导的受益人中的OR 0.36（95%可信区间，0.31，0.43）。如医疗补助资格所反映的贫困情况，并未改变西班牙裔人群全髋关节置换术几率较低的情况（符合医疗补助资格的西班牙裔人群中OR为0.25；95%可信区间，0.19，0.33；不符合医疗补助资格的西班牙裔人群中OR为0.30；95%可信区间，0.24，0.38）。
有医疗保险的西班牙裔人群接受全髋关节置换术的比例低于非西班牙裔人群。由于医疗保险涵盖全髋关节置换术，我们的研究结果表明，西班牙裔人群全髋关节置换术使用不足不能仅归因于缺乏医疗保险。
