Albright J Alex, Meghani Ozair, Lemme Nicholas J, Owens Brett D
Warren Alpert Medical School of Brown University, Providence, RI.
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
R I Med J (2013). 2022 Jun 1;105(5):56-62.
To characterize shoulder instability within the state of Rhode Island from 2011 to 2019.
The Rhode Island All-Payer Claims Database (APCD) was used to identify all patients that make an insurance claim related to a shoulder instability event. All patients in the APCD with an ICD-9 code of 718.31, 718.32, or 831.00 through 831.19 or an ICD-10 code of S43.001 through S43.086 or M24.41 through M25.319 between January 1, 2011 and December 31, 2019 were selected. Chi-square analysis was used to compare age- and sex-delimited subgroups; multivariate logistic regression was used to assess for factors influencing rates of surgical intervention and recurrent instability; and Kaplan-Meier failure and log-rank analyses was used to analyze variation in the time to surgery and recurrence between age-delimited subgroups.
The incidence of overall shoulder instability (subluxations and dislocations) in Rhode Island was 62.20 instability events (95% CI, 60.61-63.78) per 100,000 person-years. The incidence of dislocations and subluxations were 49.46 injuries (95% CI, 48.05-50.88) and 12.73 injuries (95% CI, 12.02-13.45) per 100,000 person-years, respectively. Bivariate analysis demonstrated that male patients had significantly increased rates of surgical stabilization (6.36% vs. 2.80%) and recurrent instability (16.30% vs. 9.85%) compared to their female counterparts. However, after controlling for age at the primary instability event and the type and directionality of the instability, the difference in recurrence rates between males and females is no longer statistically significant (p = 0.326). Contrary to sex, age maintained its significance with those patients aged 20 and younger and 21-40 years at significantly increased odds of surgical stabilization (3.12 and 1.99, respectively) and experiencing a recurrent instability event (3.96 and 2.77, respectively).
These data characterize the epidemiology of shoulder instability within the state of Rhode Island and demonstrate how increasing age at a primary instability event decreases the likelihood of both surgical stabilization and rates of recurrence.
描述2011年至2019年罗德岛州肩部不稳定的特征。
使用罗德岛州全支付方索赔数据库（APCD）来识别所有提出与肩部不稳定事件相关保险索赔的患者。选取2011年1月1日至2019年12月31日期间APCD中所有国际疾病分类第九版（ICD - 9）编码为718.31、718.32或831.00至831.19，或国际疾病分类第十版（ICD - 10）编码为S43.001至S43.086或M24.41至M25.319的患者。采用卡方分析比较按年龄和性别划分的亚组；使用多因素逻辑回归评估影响手术干预率和复发性不稳定的因素；使用Kaplan - Meier失败率和对数秩分析来分析按年龄划分的亚组之间手术时间和复发时间的差异。
罗德岛州总体肩部不稳定（半脱位和脱位）的发病率为每10万人年62.20次不稳定事件（95%置信区间，60.61 - 63.78）。脱位和半脱位的发病率分别为每10万人年49.46次损伤（95%置信区间，48.05 - 50.88）和12.73次损伤（95%置信区间，12.02 - 13.45）。双变量分析表明，与女性患者相比，男性患者手术稳定率（6.36%对2.80%）和复发性不稳定率（16.30%对9.85%）显著增加。然而，在控制初次不稳定事件时的年龄以及不稳定的类型和方向性后，男性和女性之间的复发率差异不再具有统计学意义（p = 0.326）。与性别相反，年龄仍然具有显著意义，20岁及以下和21 - 40岁的患者手术稳定的几率（分别为3.12和1.99）以及经历复发性不稳定事件的几率（分别为3.96和2.77）显著增加。
这些数据描述了罗德岛州肩部不稳定的流行病学特征，并表明初次不稳定事件时年龄的增加如何降低手术稳定的可能性和复发率。
