Munugoda Ishanka P, Brennan-Olsen Sharon L, Wills Karen, Cai Guoqi, Graves Stephen E, Lorimer Michelle, Cicuttini Flavia M, Callisaya Michele L, Aitken Dawn, Jones Graeme
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2022 Feb;52(2):265-271. doi: 10.1111/imj.15066.
A socioeconomic gradient exists in the utilisation of total hip replacements (THR) and total knee replacements (TKR) for osteoarthritis. However, the relations between socioeconomic status (SES) and time to THR or TKR is unknown.
To describe the association between SES and time to THR and TKR.
One thousand and seventy-two older adults residing in Tasmania, Australia, were studied. Incident primary THR and TKR were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. At baseline, each participant's area-level SES was determined using the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) from the Australian Bureau of Statistics' 2001 census data. The IRSAD was analysed in two ways: (i) categorised into quartiles, whereby quartile 1 represented the most socioeconomically disadvantaged group; and (ii) the cohort dichotomised at the quartile 1 cut-point.
The mean age was 63.0 (±7.5) years and 51% were women. Over the median follow up of 12.9 (interquartile range: 12.2-13.9) years, 56 (5%) participants had a THR and 79 (7%) had a TKR. Compared with the most disadvantaged quartile, less disadvantaged participants were less likely to have a THR (i.e. less disadvantaged participants had a longer time to THR; hazard ratio (HR): 0.56; 95% confidence interval (CI) 0.32, 1.00) but not TKR (HR: 0.90; 95% CI 0.53, 1.54). However, the former became non-significant after adjustment for pain and radiographic osteoarthritis, suggesting that the associations may be mediated by these factors.
The present study suggests that time to joint replacement was determined according to the symptoms/need of the participants rather than their SES.
骨关节炎患者进行全髋关节置换术（THR）和全膝关节置换术（TKR）的情况存在社会经济梯度差异。然而，社会经济地位（SES）与接受THR或TKR的时间之间的关系尚不清楚。
描述SES与接受THR和TKR时间之间的关联。
对居住在澳大利亚塔斯马尼亚州的1072名老年人进行了研究。通过与澳大利亚骨科协会国家关节置换登记处的数据链接确定初次发生的THR和TKR。在基线时，使用澳大利亚统计局2001年人口普查数据中的相对社会经济优势和劣势指数（IRSAD）确定每位参与者的地区层面SES。IRSAD通过两种方式进行分析：（i）分为四分位数，其中第一四分位数代表社会经济最弱势的群体；（ii）在第一四分位数切点处将队列分为两组。
平均年龄为63.0（±7.5）岁，51%为女性。在12.9年（四分位间距：12.2 - 13.9年）的中位随访期内，56名（5%）参与者接受了THR，79名（7%）参与者接受了TKR。与最弱势的四分位数相比，弱势程度较低的参与者接受THR的可能性较小（即弱势程度较低的参与者接受THR的时间较长；风险比（HR）：0.56；95%置信区间（CI）0.32，1.00），但接受TKR的情况并非如此（HR：0.90；95%CI 0.53，1.54）。然而，在对疼痛和影像学骨关节炎进行调整后，前者变得不显著，这表明这些关联可能由这些因素介导。
本研究表明，关节置换的时间是根据参与者的症状/需求而非其SES来确定的。
