Dunlop Dorothy D, Manheim Larry M, Song Jing, Sohn Min-Woong, Feinglass Joseph M, Chang Huan J, Chang Rowland W
Institute for Healthcare Studies, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Med Care. 2008 Feb;46(2):200-8. doi: 10.1097/MLR.0b013e31815cecd8.
Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.
This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries.
Longitudinal (1998-2004) Health and Retirement Study.
National probability sample of US community-dwelling adults.
A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older.
The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population.
Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences.
These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation.
近1800万美国人因关节炎而行动受限。有记录表明，在膝关节和髋关节置换等外科手术的使用方面，不同种族/族裔群体存在差异，这在很大程度上是基于65岁及以上医疗保险受益人的数据。此前尚未探讨过年轻人中是否存在差异。
本研究评估关节炎相关膝关节和髋关节手术中特定年龄的种族/族裔差异。
纵向（1998 - 2004年）健康与退休研究。
美国社区居住成年人的全国概率样本。
共有2262名51岁及以上的黑人、1292名西班牙裔和13159名白人成年人。
结果是自我报告的2年内进行关节炎相关髋关节或膝关节手术的情况。自变量包括人口统计学因素（种族/族裔、年龄、性别）、健康需求（关节炎、慢性病、肥胖、身体活动和功能受限）以及医疗可及性（收入、财富、教育和医疗保险）。使用离散生存分析的纵向数据方法有效地考虑了随时间重复（每两年一次）的观察结果。分析使用个体权重、分层和抽样误差代码，以便对美国人群进行有效的推断。
65岁以下的黑人成年人报告的髋关节/膝关节关节炎手术的年龄/性别调整率相似[风险比（HR）= 1.43，95%置信区间（CI）= 0.87 - 2.38]，而65岁及以上的黑人与白人相比，手术率显著较低（HR = 0.38，CI = 0.16 - 0.55）。在控制健康和经济差异后，这些关系依然成立。65岁以下（HR = 0.64，CI = 0.12 - 1.44）以及65岁及以上（HR = 0.60，CI = 0.32 - 1.10）的西班牙裔成年人报告的利用率较低，尽管与白人相比无统计学差异。西班牙裔差异的很大一部分可由经济差异来解释。
这些全国性数据表明，65岁及以上黑人成年人进行关节炎相关髋关节/膝关节手术的比率低于白人成年人，这与其他全国性研究一致。然而，65岁以下黑人与白人的手术利用率并无差异。两个年龄组中西班牙裔与白人相比利用率较低，这在很大程度上可由医疗可及性因素来解释。全国的利用率模式可能因年龄而异，值得进一步研究。
