San Diego State University/University of California San Diego, Joint Doctoral Program in Public Health, USA.
Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
Osteoarthritis Cartilage. 2019 Dec;27(12):1746-1754. doi: 10.1016/j.joca.2019.07.015. Epub 2019 Aug 9.
To evaluate racial and ethnic disparities in utilization of total knee arthroplasty (TKA) in relation to demographic, health, and socioeconomic status variables.
Prospective study of 102,767 Women's Health Initiative postmenopausal women initially aged 50-79, examining utilization rates of primary TKA between non-Hispanic Black/African American, non-Hispanic White, and Hispanic/Latina women (hereafter referred to as Black, White, and Hispanic). A total of 8,942 Black, 3,405 Hispanic, and 90,420 White women with linked Medicare claims data were followed until time of TKA, death, or transition from fee-for-service coverage. Absolute disparities were determined using utilization rates by racial/ethnic group and relative disparities quantified using multivariable hazards models in adjusting for age, arthritis, joint pain, mobility disability, body mass index, number of comorbidities, income, education, neighborhood socioeconomic status (SES), and geographic region.
TKA utilization was higher among White women (10.7/1,000 person-years) compared to Black (8.5/1,000 person-years) and Hispanic women (7.6/1,000 person-years). Among women with health indicators for TKA including diagnosis of arthritis, moderate to severe joint pain, and mobility disability, Black and Hispanic women were significantly less likely to undergo TKA after adjusting for age [Black: HR (95% confidence interval) = 0.70 (0.63-0.79); Hispanic: HR = 0.58 (0.44-0.77)]. Adjustment for SES modestly attenuated the measured disparity, but significant differences remained [Black: HR = 0.75 (0.67-0.89); Hispanic: HR = 0.65 (0.47-0.89)].
Compared to White women, Black and Hispanic women were significantly less likely to undergo TKA after considering need and appropriateness for TKA and SES. Further investigation into personal-level and provider-level factors that may explain these disparities is warranted.
评估与人口统计学、健康和社会经济地位变量相关的全膝关节置换术 (TKA) 的利用种族和民族差异。
对 102767 名参加妇女健康倡议的绝经后妇女进行前瞻性研究，这些妇女最初的年龄在 50-79 岁之间，研究非西班牙裔黑人和非洲裔美国、非西班牙裔白人和西班牙裔/拉丁裔妇女（以下简称黑种人、白种人和西班牙裔）之间初次 TKA 的使用率。共有 8942 名黑种人、3405 名西班牙裔和 90420 名白种妇女与医疗保险索赔数据相关联，在 TKA、死亡或从按服务收费转为医疗保险覆盖之前进行随访。通过种族/民族群体的使用率确定绝对差异，通过多变量风险模型在调整年龄、关节炎、关节疼痛、行动能力障碍、体重指数、合并症数量、收入、教育、社区社会经济地位 (SES) 和地理位置后量化相对差异。
白人妇女 TKA 的利用率（10.7/1000 人年）高于黑人（8.5/1000 人年）和西班牙裔妇女（7.6/1000 人年）。在有 TKA 健康指标的妇女中，包括关节炎诊断、中度至重度关节疼痛和行动能力障碍，调整年龄后，黑人和西班牙裔妇女接受 TKA 的可能性显著降低[黑人：HR（95%置信区间）=0.70（0.63-0.79）；西班牙裔：HR=0.58（0.44-0.77）]。SES 的调整适度减弱了所测差异，但仍存在显著差异[黑人：HR=0.75（0.67-0.89）；西班牙裔：HR=0.65（0.47-0.89）]。
与白人妇女相比，在考虑 TKA 的必要性和适当性以及 SES 后，黑人和西班牙裔妇女接受 TKA 的可能性显著降低。需要进一步调查可能解释这些差异的个人和提供者层面的因素。
