Francis Mark L, Scaife Steven L, Zahnd Whitney E
Division of Rheumatology, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA.
Arch Surg. 2011 May;146(5):579-83. doi: 10.1001/archsurg.2010.306. Epub 2011 Jan 17.
To determine whether Medicare beneficiaries in rural areas were less likely to undergo a variety of surgical procedures compared with their urban counterparts.
DESIGN, SETTING, AND PATIENTS: Cross-sectional study of Medicare beneficiaries.
Any incidence of the surgical procedures studied.
Compared with urban Medicare beneficiaries, rural Medicare beneficiaries were more likely to undergo a broad array of surgical procedures: 35% more likely for carotid endarterectomy (odds ratio [OR] = 1.35; 95% confidence interval [CI], 1.33-1.38), 32% for lumbar spine fusion (OR = 1.32; 95% CI, 1.29-1.35), 30% for knee replacement surgery (OR = 1.30; 95% CI, 1.28-1.31), 28% for abdominal aortic aneurysm repair (OR = 1.28; 95% CI, 1.24-1.31), 22% for prostatectomy (OR = 1.22; 95% CI, 1.19-1.24), 19% for hip replacement surgery (OR = 1.19; 95% CI, 1.17-1.21), 18% for aortic valve replacement (OR = 1.18; 95% CI, 1.14-1.21), 16% for open reduction and internal fixation of the femur (OR = 1.16; 95% CI, 1.14-1.18), and 15% for appendectomy (OR = 1.15; 95% CI, 1.11-1.19). To determine whether these differences could be explained by known confounding variables, we then used logistic regression to adjust for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence. Rural beneficiaries were still more likely to undergo all of these surgical procedures.
Medicare beneficiaries living in rural areas were more likely to undergo a broad array of surgical procedures compared with those living in urban areas. While allaying some concern about rural access to surgical procedures, the uniformity of these results raises concern that people living in rural areas may have an overall poorer quality of health.
确定农村地区的医疗保险受益人相比于城市地区的受益人，接受各类外科手术的可能性是否更低。
设计、研究地点与患者：对医疗保险受益人的横断面研究。
所研究外科手术的任何发生率。
与城市医疗保险受益人相比，农村医疗保险受益人更有可能接受一系列广泛的外科手术：颈动脉内膜切除术的可能性高35%（优势比[OR]=1.35；95%置信区间[CI]，1.33 - 1.38），腰椎融合术高32%（OR = 1.32；95% CI，1.29 - 1.35），膝关节置换手术高30%（OR = 1.30；95% CI，1.28 - 1.31），腹主动脉瘤修复术高28%（OR = 1.28；95% CI，1.24 - 1.31），前列腺切除术高22%（OR = 1.22；95% CI，1.19 - 1.24），髋关节置换手术高19%（OR = 1.19；95% CI，1.17 - 1.21），主动脉瓣置换术高18%（OR = 1.18；95% CI，1.14 - 1.21），股骨切开复位内固定术高16%（OR = 1.16；95% CI，1.14 - 1.18），阑尾切除术高15%（OR = 1.15；95% CI，1.11 - 1.19）。为了确定这些差异是否可以由已知的混杂变量解释，我们随后使用逻辑回归对年龄、性别、种族/民族、家庭收入中位数、平均房屋价值、平均贫困率和居住州进行了调整。农村受益人接受所有这些外科手术的可能性仍然更高。
与城市地区的医疗保险受益人相比，农村地区的医疗保险受益人更有可能接受一系列广泛的外科手术。虽然这减轻了一些对农村地区获得外科手术治疗机会的担忧，但这些结果呈现出的一致性引发了人们对农村地区居民整体健康质量可能较差的担忧。
