Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104. E-mail address for S.M. Kurtz:
Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA 94025.
J Bone Joint Surg Am. 2014 Apr 16;96(8):624-30. doi: 10.2106/JBJS.M.00285.
Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure.
Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates.
The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower.
Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.
很少有研究探讨国家卫生支出和宏观经济对全关节置换利用的影响。经济衰退引发了人们对未来全关节置换增长可持续性的质疑。美国全关节置换需求的先前预测是基于截至 2003 年的数据，使用的统计方法忽略了国家卫生支出等宏观经济因素。
利用全国住院患者样本（1993 年至 2010 年）的数据，结合美国人口普查和国家卫生支出数据，量化了全关节置换率的历史趋势，包括 21 世纪 2000 年代的两次经济衰退。使用国际疾病分类第 9 版临床修订版的代码确定原发性和翻修性髋关节和膝关节置换术。使用回归模型估计全关节置换的预测值，该模型将 1993 年至 2010 年的人口增长和关节置换率作为一个函数纳入年龄、性别、种族和人口普查区，将国家卫生支出作为自变量。该回归模型与政府对 2011 年至 2021 年国家卫生支出的预测结合使用，以估计美国各亚人群的未来关节置换率，并得出全国估计数。
关节置换发病率的增长趋势，无论是对整个美国人口还是对美国劳动力人口，都不受经济衰退的影响。从 2009 年到 2010 年，原发性全髋关节置换术的总手术量增长了 6.0%，原发性全膝关节置换术增长了 6.1%，翻修全髋关节置换术增长了 10.8%，翻修全膝关节置换术增长了 13.5%。2020 年原发性髋关节置换术的国家卫生支出模型预测值高于先前预测的模型，而目前的模型估计值则较低。
21 世纪 2000 年代的经济衰退并没有对美国髋关节和膝关节置换的全国增长趋势产生实质性影响。这些最新的更新预测为外科医生、医院、支付方和政策制定者提供了一个基础，以规划未来对全关节置换手术的需求。
