Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island.
J Arthroplasty. 2022 Oct;37(10):1973-1979.e1. doi: 10.1016/j.arth.2022.04.033. Epub 2022 Apr 29.
Despite strong evidence supporting the efficacy of total knee arthroplasty (TKA), studies have shown significant socioeconomic disparities regarding who ultimately undergoes TKA. The purpose of the current study is to evaluate socioeconomic factors affecting whether a patient undergoes TKA after a diagnosis of osteoarthritis.
From 2011 to 2018, claims for adult patients diagnosed with knee osteoarthritis in the New York Statewide Planning and Research Cooperative System (SPARCS) database were analyzed. International Classification of Diseases (ICD), 9/10 CM codes were used to identify the initial diagnosis for each patient. ICD 9/10 PCS codes were used to identify subsequent TKA. Logistic regression analysis was performed to determine the effect of patient factors on the likelihood of having TKA.
Of 313,794 osteoarthritis diagnoses, 33.3% proceeded to undergo TKA. Increased age (OR 1.007, P < .0001) and workers' compensation relative to commercial insurance (OR 1.865, P < .0001) had increased odds of TKA. Compared to White race, Asian (OR 0.705, P < .0001), Black (OR 0.497, P < .0001), and "other" race (OR 0.563, P < .0001) had lower odds of TKA. Hispanic ethnicity (OR 0.597, P < .0001) had lower odds of surgery. Compared to commercial insurance, Medicare (OR 0.876, P < .0001), Medicaid (OR 0.452, P < .0001), self-pay (OR 0.523, P < .0001), and "other" insurance (OR 0.819, P < .0001) had lower odds of TKA. Increased social deprivation (OR 0.987, P < .0001) had lower odds of TKA.
TKA is associated with disparities among race, ethnicity, primary insurance, and social deprivation. Additional research is necessary to identify the cause of these disparities to improve equity in orthopedic care.
尽管有强有力的证据支持全膝关节置换术（TKA）的疗效，但研究表明，在最终接受 TKA 的人群方面，存在显著的社会经济差异。本研究的目的是评估影响膝关节骨关节炎患者接受 TKA 的社会经济因素。
2011 年至 2018 年，对纽约州规划和研究合作系统（SPARCS）数据库中诊断为膝骨关节炎的成年患者的索赔进行了分析。国际疾病分类（ICD）第 9/10 版 CM 代码用于确定每位患者的初始诊断。ICD 9/10 PCS 代码用于确定随后的 TKA。采用逻辑回归分析确定患者因素对 TKA 可能性的影响。
在 313794 例骨关节炎诊断中，33.3%的患者接受了 TKA。与商业保险相比，年龄增加（OR 1.007，P <.0001）和工人赔偿（OR 1.865，P <.0001）增加了 TKA 的可能性。与白人相比，亚洲人（OR 0.705，P <.0001）、黑人（OR 0.497，P <.0001）和“其他”种族（OR 0.563，P <.0001）接受 TKA 的可能性较低。西班牙裔（OR 0.597，P <.0001）接受手术的可能性较低。与商业保险相比，医疗保险（OR 0.876，P <.0001）、医疗补助（OR 0.452，P <.0001）、自付（OR 0.523，P <.0001）和“其他”保险（OR 0.819，P <.0001）接受 TKA 的可能性较低。社会贫困程度增加（OR 0.987，P <.0001）降低了接受 TKA 的可能性。
TKA 与种族、民族、主要保险和社会贫困程度存在差异。需要进一步研究以确定这些差异的原因，从而改善骨科护理的公平性。
