Chun Danielle S, Leonard Annemarie K, Enchill Zenaida, Suleiman Linda I
Department of Orthopaedic Surgery, Northwestern University, 259 E. Erie St. 13th Floor, Chicago, IL, 60611, USA.
Curr Rev Musculoskelet Med. 2021 Dec;14(6):434-440. doi: 10.1007/s12178-021-09718-3. Epub 2021 Oct 9.
The primary aim of this review was to evaluate recently published total joint arthroplasty (TJA) studies in order to accurately summarize the current concepts regarding racial and ethnic disparities in total joint arthroplasty.
Many studies found that racial and ethnic disparities in TJA are present in all phases of arthroplasty care including access to, utilization of, and postoperative outcomes after TJA. Factors that limit patient access to TJA-increased patient comorbidities, lower socioeconomic status, and Medicaid/uninsured status-are also disproportionately associated with underrepresented patient populations. Minority patients are more likely to require more intensive postoperative rehabilitation and non-home discharge placement. This in turn potentially adds additional concerns regarding hospital/provider reimbursement in light of the current Medicare/Medicaid model for arthroplasty surgeons, thus creating a recurrent cycle in which disparities in TJA reflect the complex interplay of overall health disparities and access inequalities associated with racial and ethnic biases. Literature demonstrating evidenced-based interventions to minimize these disparities is sparse, but the multifactorial cause of disparities in TJA highlights the need for multifaceted solutions on both a systemic and individual level.
本综述的主要目的是评估近期发表的全关节置换术（TJA）研究，以便准确总结当前关于全关节置换术中种族和民族差异的概念。
许多研究发现，TJA中的种族和民族差异存在于关节置换护理的各个阶段，包括获得TJA的机会、TJA的使用情况以及TJA术后的结果。限制患者获得TJA的因素——患者合并症增加、社会经济地位较低以及医疗补助/未参保状态——也与代表性不足的患者群体不成比例地相关。少数族裔患者更有可能需要更强化的术后康复和非家庭出院安置。鉴于目前针对关节置换外科医生的医疗保险/医疗补助模式，这反过来可能会增加对医院/提供者报销的额外担忧，从而形成一个循环，其中TJA的差异反映了整体健康差异以及与种族和民族偏见相关的获得机会不平等之间的复杂相互作用。证明基于证据的干预措施以尽量减少这些差异的文献很少，但TJA差异的多因素成因凸显了在系统和个体层面都需要多方面解决方案。
