Ang Dennis C, James Golda, Stump Timothy E
Indiana University School of Medicine, Indianapolis, IN 46202, USA. dang@
Arthritis Rheum. 2009 Dec 15;61(12):1677-85. doi: 10.1002/art.24944.
To understand the reasons behind racial disparities in the use of total joint arthroplasty (TJA), we sought to examine the predictors of time to referral to orthopedic surgery for consideration of joint replacement.
In this prospective, longitudinal study of 676 primary care clinic patients with at least a moderately severe degree of hip or knee osteoarthritis (OA), we examined the effects of race, health beliefs (i.e., perceived benefits and risks) of TJA, and clinical appropriateness of TJA on referral to orthopedic surgery.
The sample included 255 African Americans (38%) and 421 whites (62%); 523 patients had knee OA (78%) and 153 had hip OA (22%). Subjects were 60% male, with a mean +/- SD age of 64 +/- 9 years, a mean +/- SD body mass index of 33.6 +/- 8 kg/m(2), and a mean +/- SD summary Western Ontario and McMaster Universities Osteoarthritis Index score of 56 +/- 14, suggesting moderately severe OA. At baseline, African Americans perceived fewer benefits and greater risk from TJA than whites. There were no significant racial group differences in the proportions of cases deemed clinically appropriate for TJA. After controlling for potential confounders, clinical appropriateness (hazard ratio [HR] 1.95, 95% confidence interval [95% CI] 1.15-3.32; P = 0.01) predicted referral to orthopedic surgery. Neither race (HR 1.30, 95% CI 0.94-2.05; P = 0.1) nor health beliefs (HR 1.0, P = 0.5) were associated with referral status.
In this sample of primary care clinic patients, African Americans and whites were equally likely to be referred by their physicians to orthopedic surgery. Clinical appropriateness predicted future referral to orthopedic surgery, and not race or TJA-specific health beliefs.
为了解全关节置换术（TJA）使用方面种族差异背后的原因，我们试图研究转诊至骨科手术以考虑关节置换的时间预测因素。
在这项对676例患有至少中度严重程度髋或膝骨关节炎（OA）的初级保健诊所患者进行的前瞻性纵向研究中，我们研究了种族、TJA的健康观念（即感知到的益处和风险）以及TJA的临床适宜性对转诊至骨科手术的影响。
样本包括255名非裔美国人（38%）和421名白人（62%）；523例患者患有膝OA（78%），153例患有髋OA（22%）。受试者60%为男性，平均年龄±标准差为64±9岁，平均体重指数±标准差为33.6±8kg/m²，平均±标准差的西安大略和麦克马斯特大学骨关节炎指数总评分56±14，提示为中度严重OA。在基线时，非裔美国人比白人感知到TJA的益处更少且风险更大。在被认为临床适合TJA的病例比例方面，种族组间无显著差异。在控制潜在混杂因素后，临床适宜性（风险比[HR]1.95，95%置信区间[95%CI]1.15 - 3.32；P = 0.01）可预测转诊至骨科手术。种族（HR 1.30，95%CI 0.94 - 2.05；P = 0.1）和健康观念（HR 1.0，P = 0.5）均与转诊状态无关。
在这个初级保健诊所患者样本中，非裔美国人和白人被医生转诊至骨科手术的可能性相同。临床适宜性可预测未来转诊至骨科手术，而非种族或TJA特定的健康观念。
