1 Department of Anesthesiology, Weill Cornell Medicine, Center for Perioperative Outcomes , New York, New York.
2 Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine , New York, New York.
Popul Health Manag. 2019 Apr;22(2):175-185. doi: 10.1089/pop.2018.0025. Epub 2018 Jun 29.
Previous studies have addressed racial/ethnic and socioeconomic disparities in total knee arthroplasty (TKA) within the Medicare population. However, there is limited research examining these disparities across racial/ethnic and socioeconomic groups in the general population. This study used administrative data from the State Inpatient Databases from the Healthcare Cost and Utilization Project for the years 2007-2014 from California (2007-2011 only), Florida, New York, and Maryland (2012-2014 only). In all, 739,857 TKA readmission-eligible patients aged ≥8 years were included in the analysis. Black patients and patients with Medicaid had a higher likelihood of 30- and 90-day readmissions compared to white patients and patients with private insurance, respectively. Patients living in higher median income areas and patients treated at higher volume hospitals had lower likelihoods of 30- and 90-day readmissions compared to patients in the lowest median income quartile and patients treated at the lowest volume hospitals, respectively. These results confirmed racial/ethnic and socioeconomic disparities in TKA readmissions across 4 geographically diverse states, identified public insurance status as the salient factor across subpopulations, and raise awareness of the existence of these disparities outside of the Medicare population.
先前的研究已经探讨了医疗保险人群中全膝关节置换术（TKA）的种族/民族和社会经济差异。然而，关于在一般人群中跨种族/民族和社会经济群体的这些差异的研究有限。本研究使用了来自加利福尼亚州（2007-2011 年仅）、佛罗里达州、纽约州和马里兰州的医疗保健成本和利用项目州住院数据库的行政数据，这些数据来自 2007-2014 年。总共纳入了 739,857 名符合 30 天和 90 天再入院条件的≥8 岁 TKA 患者。与白人患者和私人保险患者相比，黑人患者和医疗补助患者的 30 天和 90 天再入院的可能性更高。与收入最低四分位数的患者和接受最低容量医院治疗的患者相比，居住在中等收入中位数较高地区的患者和在高容量医院接受治疗的患者的 30 天和 90 天再入院的可能性较低。这些结果证实了四个地理位置不同的州在 TKA 再入院方面的种族/民族和社会经济差异，确定了公共保险状况是各亚群中的显著因素，并提高了对医疗保险人群之外存在这些差异的认识。
