University hospital centre of Caen, department of rheumatology, Caen, 14000, France; University of Caen Normandie, medical school, Caen, 14000, France.
Inserm, university of Caen research U1086 Anticipe, Caen, 14076, France.
Joint Bone Spine. 2019 Oct;86(5):637-641. doi: 10.1016/j.jbspin.2019.03.004. Epub 2019 Mar 22.
Temporal and geographic variations in knee osteoarthritis (OA) incidence occur worldwide. Regional variations also exist for socioeconomic status. We analyzed the association between socioeconomic deprivation (SED) and knee replacement (KR) incidence and assessed the proportion of KR associated with affluence.
Patients aged 15 years and over hospitalized for KR in 2013 were included. We linked each patient to a municipality of residence. Municipalities were matched to the 2011 European Deprivation Index score for SED analysis. Poisson regression was performed to examine the association between KR incidence and EDI adjusted for age and sex. The Population Attributable Fraction (PAF) was measured to calculate the proportion of excess of KR associated with social affluence.
We included 77 597 KR. KR incidence decreased with increasing SED index. The EDI was significantly associated with KR incidence (P < 0.0001). The risk of KR is 2.36 times higher for persons living in the most affluent area compared to those living in the most underprivileged area. The PAF was 28.3%.
The French administrative municipalities with the highest SED have the lowest age- and sex-adjusted KR incidence. It cannot be excluded that patients living in more privileged areas are overtreated. Complementary studies are necessary to define all the individual factors that limit or increase the access to knee replacement.
膝骨关节炎（OA）的发病率在全球范围内存在时间和地域差异。社会经济地位也存在地域差异。我们分析了社会经济剥夺（SED）与膝关节置换（KR）发病率之间的关系，并评估了富裕程度与 KR 相关的比例。
纳入 2013 年因 KR 住院的年龄在 15 岁及以上的患者。我们将每位患者与居住地的市进行匹配。将各市与 2011 年欧洲剥夺指数得分进行匹配，用于 SED 分析。采用泊松回归分析年龄和性别调整后的 EDI 与 KR 发病率之间的关系。测量人群归因分数（PAF）以计算与社会富裕相关的 KR 过剩比例。
我们纳入了 77597 例 KR。KR 发病率随 SED 指数的增加而降低。EDI 与 KR 发病率显著相关（P<0.0001）。与生活在最贫困地区的人相比，生活在最富裕地区的人发生 KR 的风险高 2.36 倍。PAF 为 28.3%。
SED 最高的法国行政区的 KR 发病率最低，且经年龄和性别调整。不能排除生活在特权地区的患者接受过度治疗的可能性。有必要进行补充研究，以确定限制或增加膝关节置换术获得的所有个体因素。
