Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, Msida, Malta.
Faculty of Medicine and Surgery, University of Malta Medical School, Msida, Malta.
Knee Surg Sports Traumatol Arthrosc. 2023 Feb;31(2):691-700. doi: 10.1007/s00167-022-07103-2. Epub 2022 Sep 6.
The aim of this study was to describe the epidemiology of Achilles tendon rupture (ATR) and its relationship with socioeconomic deprivation status (SEDS). The hypothesis was that ATR occurs more frequently in socioeconomically deprived patients. Secondary aims were to determine variations in circumstances of injury between more and less deprived patients.
A 6-year retrospective review of consecutive patients presenting with ATR was undertaken. The health-board population was defined using governmental population data and SEDS was defined using the Scottish Index of Multiple Deprivation. The primary outcome was an epidemiological description and comparison of incidence in more and less deprived cohorts. Secondary outcomes included reporting of the relationship between SEDS and patient and injury characteristics with univariate and binary logistic regression analyses.
There were 783 patients (567 male; 216 female) with ATR. Mean incidence for adults (≥ 18 years) was 18.75/100,000 per year (range 16.56-23.57) and for all ages was 15.26/100,000 per year (range 13.51 to 19.07). Incidence in the least deprived population quintiles (4th and 5th quintiles; 18.07 per 100,000/year) was higher than that in the most deprived quintiles (1st and 2nd; 11.32/100,000 per year; OR 1.60, 95%CI 1.35-1.89; p < 0.001). When adjusting for confounding factors, least deprived patients were more likely to be > 50 years old (OR 1.97; 95%CI 1.24-3.12; p = 0.004), to sustain ATR playing sports (OR 1.72, 95%CI 1.11-2.67; p = 0.02) and in the spring (OR 1.65, 95%CI 1.01-2.70; p = 0.045) and to give a history of preceding tendinitis (OR 4.04, 95%CI 1.49-10.95; p = 0.006). They were less likely to sustain low-energy injuries (OR 0.44, 95%CI 0.23-0.87; p = 0.02) and to be obese (OR 0.25-0.41, 95%CI 0.07-0.90; p ≤ 0.03).
The incidence of ATR was higher in less socioeconomically deprived populations and the hypothesis was therefore rejected. Significant variations in patient and predisposing factors, mechanisms of injury and seasonality were demonstrated between most and least deprived groups, suggesting that circumstances and nature of ATR may vary with SEDS and these are not a homogenous group of injuries.
Prognostic Study Level III.
本研究旨在描述跟腱断裂（ATR）的流行病学特征及其与社会经济剥夺状况（SEDS）的关系。假设是 ATR 更常发生在社会经济上处于劣势的患者中。次要目的是确定更贫困和较不贫困患者之间受伤情况的差异。
对连续出现 ATR 的患者进行了 6 年的回顾性研究。使用政府人口数据定义卫生委员会的人口，使用苏格兰多重剥夺指数（Scottish Index of Multiple Deprivation）定义 SEDS。主要结局是对更多和更少贫困人群的发病率进行流行病学描述和比较。次要结局包括报告 SEDS 与患者和损伤特征之间的关系，使用单变量和二元逻辑回归分析。
共有 783 名（567 名男性；216 名女性）患有 ATR。成年人（≥18 岁）的平均发病率为每年 18.75/100,000（范围 16.56-23.57），所有年龄段的发病率为每年 15.26/100,000（范围 13.51 至 19.07）。在最不贫困的五分位数（第四和五分位数；每年 18.07/100,000）的发病率高于最贫困的五分位数（第一和第二五分位数；每年 11.32/100,000；OR 1.60，95%CI 1.35-1.89；p<0.001）。在调整混杂因素后，最不贫困的患者更有可能年龄>50 岁（OR 1.97；95%CI 1.24-3.12；p=0.004），更有可能因运动而发生 ATR（OR 1.72，95%CI 1.11-2.67；p=0.02），更有可能在春季（OR 1.65，95%CI 1.01-2.70；p=0.045），且有既往腱炎病史（OR 4.04，95%CI 1.49-10.95；p=0.006）。他们不太可能发生低能量损伤（OR 0.44，95%CI 0.23-0.87；p=0.02），也不太可能肥胖（OR 0.25-0.41，95%CI 0.07-0.90；p≤0.03）。
ATR 的发病率在社会经济地位较低的人群中较高，因此该假设被否定。最贫困和最不贫困两组之间在患者和诱发因素、损伤机制和季节性方面存在显著差异，表明 ATR 的情况和性质可能因 SEDS 而有所不同，且这些损伤并非同质群体。
预后研究，III 级。
