Loyola-Sanchez Adalberto, Hurd Kelle, Barnabe Cheryl
Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada T2N 4N1.
Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada T2N 4N1.
Semin Arthritis Rheum. 2017 Apr;46(5):665-674. doi: 10.1016/j.semarthrit.2016.10.011. Epub 2016 Nov 1.
Indigenous populations of Australia, Canada, New Zealand, and the United States of America (USA) experience a higher prevalence of arthritis conditions. Differences in clinical outcomes and mortality may reflect healthcare service use inequities. The objective of this study was to summarize healthcare service use patterns described in the existing literature in order to identify gaps and inform strategies to limit the pronounced negative impact of arthritis on Indigenous populations.
Medline, EMBASE, CINAHL, and Indigenous-specific electronic databases (to June 2015) were used to identify cohort, case-control and cross-sectional studies describing healthcare service use by Indigenous populations with specified inflammatory arthritis, osteoarthritis, or rheumatic disease conditions. We extracted information on the study setting and methodology, primary outcome and assessed study quality, and risk of bias.
In total, 19 studies were identified describing three types of healthcare service use: physician visits, hospitalizations, and surgeries. In Canada and New Zealand, Indigenous populations had 36-51% fewer visits to specialists than the non-Indigenous population. Indigenous populations in Canada, New Zealand, and the USA had 37-300% more hospitalizations due to arthritis complications than the non-Indigenous population. Indigenous populations in Australia, Canada, and New Zealand had 27-85% fewer arthroplasties for osteoarthritis than the non-Indigenous population.
Indigenous populations had higher hospitalization rates but lower use of specialized services for arthritis conditions. Strategies to improve access to specialized arthritis services might reduce health outcome inequities.
澳大利亚、加拿大、新西兰和美利坚合众国（美国）的原住民患关节炎疾病的比例较高。临床结果和死亡率的差异可能反映了医疗服务使用的不平等。本研究的目的是总结现有文献中描述的医疗服务使用模式，以找出差距并为限制关节炎对原住民产生显著负面影响的策略提供依据。
使用Medline、EMBASE、CINAHL和特定于原住民的电子数据库（截至2015年6月）来识别队列研究、病例对照研究和横断面研究，这些研究描述了患有特定炎症性关节炎、骨关节炎或风湿性疾病的原住民的医疗服务使用情况。我们提取了关于研究背景和方法、主要结局的信息，并评估了研究质量和偏倚风险。
总共识别出19项研究，描述了三种医疗服务使用类型：看医生、住院和手术。在加拿大和新西兰，原住民看专科医生的次数比非原住民少36 - 51%。加拿大、新西兰和美国的原住民因关节炎并发症住院的次数比非原住民多37 - 300%。澳大利亚、加拿大和新西兰的原住民因骨关节炎进行关节置换术的次数比非原住民少27 - 85%。
原住民的住院率较高，但在关节炎疾病方面使用专科服务的比例较低。改善获得专科关节炎服务的策略可能会减少健康结果的不平等。
