Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
BMC Musculoskelet Disord. 2019 Sep 2;20(1):400. doi: 10.1186/s12891-019-2766-y.
The recent increase in knee arthroplasty (KA) use in Korea is among the highest in the world. The rapid increase in KA use suggests that the KA use in Korea could have been affected by medically unjustifiable factors. This study aimed to examine the geographic variation in the rate of KA and its associated factors in Korea.
We used the data from the National Health Insurance in Korea in 2013, from which a total of 67,086 claims for KA were obtained. We calculated the age-sex-standardized KA rates of the entire population and the crude rates of the age groups 0-64 and 65 and over in 251 districts. We assessed the geographic variation of the KA rates and examined the associated factors with a multivariate linear regression with the KA rate as a dependent variable.
The overall rate of KA in Korea was 132.7 per 100,000 persons. The rates of KA showed a four-fold variation. The deprivation index score and the number of beds in the small to medium sized hospitals showed a positive association with the rates of KA while the number of orthopedic surgeons showed a negative association.
Korea has been experiencing a rapid increase in the use of KA for the last decade or so, which was most prominent among the elderly population aged 65 and older. Our results suggest that the higher rate of KA is strongly related to a higher supply of beds and the socioeconomically deprived conditions. Considering that the decision concerning KA has room for discretion and also affects a considerable portion of health care expenditures, the use of KA should be thoroughly monitored with more emphasis on standardization in the decision making process and preventive measures that can lessen the need for KA.
韩国膝关节置换术（KA）的使用量近年来增长迅速，居世界之首。KA 使用量的快速增长表明，韩国的 KA 使用可能受到了不合理的医疗因素的影响。本研究旨在探讨韩国 KA 使用率的地域差异及其相关因素。
我们使用了韩国国家健康保险 2013 年的数据，从中获得了总共 67086 例 KA 的索赔。我们计算了整个人群的年龄性别标准化 KA 率以及 0-64 岁和 65 岁及以上年龄组的粗率。我们评估了 KA 率的地域差异，并使用多元线性回归分析了 KA 率作为因变量的相关因素。
韩国 KA 的总体发生率为每 100000 人 132.7 例。KA 的发生率存在四倍的差异。贫困指数评分和中小医院的床位数量与 KA 的发生率呈正相关，而骨科医生的数量与 KA 的发生率呈负相关。
在过去的十年左右，韩国的 KA 使用量一直在迅速增加，其中 65 岁及以上的老年人口增长最为显著。我们的研究结果表明，KA 使用率较高与较高的床位供应和社会经济贫困条件密切相关。考虑到 KA 的决策有一定的自由裁量权，并且也会影响相当一部分医疗保健支出，KA 的使用应受到更严格的监测，并更加注重决策过程的标准化和可以减少 KA 需求的预防措施。
