Steel N, Melzer D, Gardener E, McWilliams B
Primary Care Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK.
Rheumatology (Oxford). 2006 Nov;45(11):1437-41. doi: 10.1093/rheumatology/kel131. Epub 2006 Apr 21.
Hip and knee joint replacements are effective, and yet little is known about how closely the need for joint replacement matches supply in different population groups. Our objective was to compare the prevalence of existing joint replacements with that of need in population groups in England.
A total of 7101 people aged 60 yrs or older, representative of the population of England, were interviewed. Participants were asked about both receipt and need for joint replacement, socio-economic status and co-morbidity. 'Need' classification was based on hip or knee pain and difficulty walking, with adjustment for potential surgical contraindications. Associations between participants' characteristics and both need and receipt were estimated.
The prevalence of existing joint replacement (receipt) was 6% [95% confidence intervals (CI) 5, 6], and this was lower in the North than the South [adjusted odds ratio (OR) 0.72, CI 0.53, 0.96]. In contrast, the prevalence of estimated need was higher in the North (OR 1.27, CI 1.03, 1.58). Need was greater in women than men (OR 1.30, CI 1.09, 1.53), and showed an increasing gradient from the wealthiest to poorest quintile (ORs 1.00, 1.52, 2.18, 2.49, 3.23). In contrast, receipt did not differ significantly by sex or socio-economic group.
People living in the North of England, women and the less wealthy experience relatively high levels of need, yet do not receive relatively more hip and knee joint replacements.
髋关节和膝关节置换术效果显著，但对于不同人群中关节置换需求与供给的匹配程度却知之甚少。我们的目的是比较英格兰不同人群中现有关节置换的患病率与需求患病率。
对7101名60岁及以上、具有英格兰人口代表性的人群进行了访谈。询问参与者关于关节置换的接受情况和需求、社会经济状况及合并症。“需求”分类基于髋部或膝部疼痛及行走困难，并对潜在手术禁忌症进行了调整。估计了参与者特征与需求和接受情况之间的关联。
现有关节置换（接受）的患病率为6%[95%置信区间（CI）5，6]，北方低于南方[调整后的优势比（OR）0.72，CI 0.53，0.96]。相比之下，估计需求的患病率在北方更高（OR 1.27，CI 1.03，1.58）。女性的需求高于男性（OR 1.30，CI 1.09，1.53），且从最富有到最贫穷五分位数呈现出递增梯度（OR分别为1.00、1.52、2.18、2.49、3.23）。相比之下，接受情况在性别或社会经济群体方面没有显著差异。
生活在英格兰北部、女性和较贫困人群的需求水平相对较高，但接受的髋关节和膝关节置换手术相对较少。
