Harcombe Helen, Davie Gabrielle, Derrett Sarah, Abbott Haxby, Gwynne-Jones David
Lecturer, Preventive and Social Medicine, University of Otago, Dunedin.
Senior Research Fellow, Preventive and Social Medicine, University of Otago, Dunedin.
N Z Med J. 2016 Sep 23;129(1442):8-18.
This study examines equity in the provision of publicly-funded hip and knee total joint replacement (TJR) surgery in New Zealand between 2006 and 2013 to: 1) investigate national rates by demographic characteristics; 2) describe changes in national rates over time; and 3) compare rates of provision between District Health Boards (DHBs).
Hospital discharge data for people aged 20 years or over who had at least one hip or knee TJR between 2006 and 2013 was obtained from the Ministry of Health's National Minimum Dataset.
Higher TJR rates were observed among those aged 75-84 years, females, those of Māori ethnicity, those not living in rural or main urban areas and those in the most deprived socio-economic groups. TJRs increased from 7,053 in 2006 to 8,429 in 2013, however the rate was highest in 2007. In 2012-13, age-ethnicity-standardised rates varied between DHBs from 196 to 419/100,000 person years, with larger DHBs having lower rates than smaller DHBs.
There was evidence of geographic inequity in TJR provision across New Zealand. Despite increased numbers of procedures, rates of publicly-funded TJR surgery are barely keeping up with population increases. Reasons behind differences in provision should be examined.
本研究考察2006年至2013年间新西兰公立资助的髋关节和膝关节全关节置换（TJR）手术的公平性，以：1）按人口统计学特征调查全国手术率；2）描述全国手术率随时间的变化；3）比较各地区卫生局（DHBs）之间的手术率。
从卫生部的全国最低数据集获取2006年至2013年间年龄在20岁及以上且至少接受过一次髋关节或膝关节TJR手术的患者的医院出院数据。
在75 - 84岁人群、女性、毛利族、非农村或主要城市地区居民以及社会经济最贫困群体中观察到较高的TJR率。TJR手术从2006年的7053例增加到2013年的8429例，但2007年的手术率最高。在2012 - 13年，各地区卫生局年龄 - 种族标准化率在每10万人年196至419例之间，较大的地区卫生局的手术率低于较小的地区卫生局。
有证据表明新西兰TJR手术的提供存在地理不公平现象。尽管手术数量有所增加，但公立资助的TJR手术率几乎跟不上人口增长。应研究手术率差异背后的原因。
