Borkhoff Cornelia M, Hawker Gillian A, Kreder Hans J, Glazier Richard H, Mahomed Nizar N, Wright James G
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario.
CMAJ. 2008 Mar 11;178(6):681-7. doi: 10.1503/cmaj.071168.
The underuse of total joint arthroplasty in appropriate candidates is more than 3 times greater among women than among men. When surveyed, physicians report that the patient's sex has no effect on their decision-making; however, what occurs in clinical practice may be different. The purpose of our study was to determine whether patients' sex affects physicians' decisions to refer a patient for, or to perform, total knee arthroplasty.
Seventy-one physicians (38 family physicians and 33 orthopedic surgeons) in Ontario performed blinded assessments of 2 standardized patients (1 man and 1 woman) with moderate knee osteoarthritis who differed only by sex. The standardized patients recorded the physicians' final recommendations about total knee arthroplasty. Four surgeons did not consent to the inclusion of their data. After detecting an overall main effect, we tested for an interaction with physician type (family physician v. orthopedic surgeon). We used a binary logistic regression analysis with a generalized estimating equation approach to assess the effect of patients' sex on physicians' recommendations for total knee arthroplasty.
In total, 42% of physicians recommended total knee arthroplasty to the male but not the female standardized patient, and 8% of physicians recommended total knee arthroplasty to the female but not the male standardized patient (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.4-7.3, p < 0.001; risk ratio [RR] 2.1, 95% CI 1.5-2.8, p < 0.001). The odds of an orthopedic surgeon recommending total knee arthroplasty to a male patient was 22 times (95% CI 6.4-76.0, p < 0.001) that for a female patient. The odds of a family physician recommending total knee arthroplasty to a male patient was 2 times (95% CI 1.04-4.71, p = 0.04) that for a female patient.
Physicians were more likely to recommend total knee arthroplasty to a male patient than to a female patient, suggesting that gender bias may contribute to the sex-based disparity in the rates of use of total knee arthroplasty.
在合适的全关节置换术候选患者中，女性未充分使用该手术的情况比男性多3倍以上。在接受调查时，医生表示患者的性别对他们的决策没有影响；然而，临床实践中的情况可能有所不同。我们研究的目的是确定患者的性别是否会影响医生将患者转诊进行全膝关节置换术或实施该手术的决策。
安大略省的71名医生（38名家庭医生和33名骨科医生）对2名标准化患者（1名男性和1名女性）进行了盲法评估，这两名患者均患有中度膝骨关节炎，仅性别不同。标准化患者记录了医生关于全膝关节置换术的最终建议。4名外科医生不同意纳入他们的数据。在检测到总体主效应后，我们测试了与医生类型（家庭医生与骨科医生）的交互作用。我们使用二元逻辑回归分析和广义估计方程方法来评估患者性别对医生全膝关节置换术建议的影响。
总体而言，42%的医生向男性标准化患者而非女性标准化患者推荐了全膝关节置换术，8%的医生向女性标准化患者而非男性标准化患者推荐了全膝关节置换术（优势比[OR]4.2，95%置信区间[CI]2.4 - 7.3，p < 0.001；风险比[RR]2.1，95%CI 1.5 - 2.8，p < 0.001）。骨科医生向男性患者推荐全膝关节置换术的几率是向女性患者推荐几率的22倍（95%CI 6.4 - 76.0，p < 0.001）。家庭医生向男性患者推荐全膝关节置换术的几率是向女性患者推荐几率的2倍（95%CI 1.04 - 4.71，p = 0.04）。
医生向男性患者推荐全膝关节置换术的可能性高于女性患者，这表明性别偏见可能导致了全膝关节置换术使用率的性别差异。
