Smith M C, Ben-Shlomo Y, Dieppe P, Beswick A D, Adebajo A O, Wilkinson J M, Blom A W
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Osteoarthritis Cartilage. 2017 Apr;25(4):448-454. doi: 10.1016/j.joca.2016.12.030. Epub 2017 Jan 31.
Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined whether ethnic differences exist in joint replacement rates and surgical practice in England.
373,613 hip and 428,936 knee National Joint Registry (NJR) primary replacement patients had coded ethnicity in Hospital Episode Statistics (HES). Age and gender adjusted observed/expected ratios of hip and knee replacements amongst ethnic groups were compared using indirect standardisation. Associations between ethnic group and type of procedure were explored and effects of demographic, clinical and hospital-related factors examined using multivariable logistic regression.
Adjusted standardised observed/expected ratios were substantially lower in Blacks and Asians than Whites for hip replacement (Blacks 0.33 [95% CI, 0.31-0.35], Asians 0.20 [CI, 0.19-0.21]) and knee replacement (Blacks 0.64 [CI, 0.61-0.67], Asians 0.86 % [CI, 0.84-0.88]). Blacks were more likely to receive uncemented hip replacements (Blacks 52%, Whites 37%, Asians 44%; P < 0.001). Black men and women aged <70 years were less likely to receive unicondylar or patellofemoral knee replacements than Whites (men 10% vs 15%, P = 0.001; women 6% vs 14%, P < 0.001). After adjustment for demographic, clinical and hospital-related factors, Blacks were more likely to receive uncemented hip replacement (OR 1.43 [CI, 1.11-1.84]).
In England, hip and knee replacement rates and prosthesis type given differ amongst ethnic groups. Whether these reflect differences in clinical need or differential access to treatment requires urgent investigation.
尽管英国的医疗保健系统在提供服务时是免费的，但少数族裔患者获得的医疗服务可能并不总是与白人患者公平。我们研究了英国关节置换率和手术操作中是否存在种族差异。
373613例髋关节和428936例膝关节国家关节注册中心（NJR）初次置换患者在医院事件统计（HES）中有编码的种族信息。使用间接标准化方法比较各族裔中髋关节和膝关节置换的年龄和性别调整后的观察/预期比率。探讨种族与手术类型之间的关联，并使用多变量逻辑回归分析人口统计学、临床和医院相关因素的影响。
黑人与亚洲人的髋关节置换调整后标准化观察/预期比率显著低于白人（黑人0.33[95%CI，0.31 - 0.35]，亚洲人0.20[CI，0.19 - 0.21]）以及膝关节置换（黑人0.64[CI，0.61 - 0.67]，亚洲人0.86%[CI，0.84 - 0.88]）。黑人接受非骨水泥型髋关节置换的可能性更高（黑人52%，白人37%，亚洲人44%；P < 0.001）。年龄<70岁的黑人男性和女性接受单髁或髌股关节膝关节置换的可能性低于白人（男性10%对15%，P = 0.001；女性6%对14%，P < 0.001）。在对人口统计学、临床和医院相关因素进行调整后，黑人接受非骨水泥型髋关节置换的可能性更高（OR 1.43[CI，1.11 - 1.84]）。
在英国，各族裔之间髋关节和膝关节置换率以及所使用的假体类型存在差异。这些差异是反映临床需求的不同还是治疗获取途径的差异，需要紧急调查。
