Depetment of Medieine and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Ann Rheum Dis. 2023 Feb;82(2):283-291. doi: 10.1136/ard-2022-222779. Epub 2022 Sep 16.
Our aim was to compare patterns of musculoskeletal-related healthcare utilisation between male and female patients before and after the diagnosis of inflammatory arthritis (IA).
We used Ontario administrative health data to create three inception cohorts of adult patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) diagnosed between April 2010 and March 2017. Healthcare utilisation indicators including visits to physicians, and use of musculoskeletal imaging and laboratory tests were assessed in each year for 3 years before and after diagnosis and compared between male and female patients using regression models adjusting for sociodemographic factors and comorbidities. Results were reported as ORs with 95% CIs for female patients compared with male patients.
A total of 41 277 patients with RA (69% female), 8150 patients with AS (51% female) and 6446 patients with PsA (54% female) were analysed.Similar trends of sex-related differences were observed in all three cohorts. Before diagnosis, female patients were more likely to visit rheumatologists (OR 1.32-2.28) and family physicians (OR 1.03-1.15) for musculoskeletal reasons, whereas male patients were more likely to visit the emergency for musculoskeletal reasons (OR 0.76-0.87). A similar female predominance was observed regarding musculoskeletal imaging and laboratory tests before diagnosis. After diagnosis, female patients were more likely to remain in rheumatology care (OR 1.12-1.24).
Female patients with IA have higher healthcare utilisation than male patients which may indicate biological differences in disease course or sociocultural differences in healthcare-seeking behaviour.
本研究旨在比较炎症性关节炎（IA）诊断前后男性和女性患者的肌肉骨骼相关医疗保健利用模式。
我们使用安大略省的行政健康数据创建了三个成年患者队列，这些患者分别患有类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病关节炎（PsA），诊断时间在 2010 年 4 月至 2017 年 3 月之间。在诊断前 3 年的每年中，评估了包括就诊医师次数、肌肉骨骼影像学和实验室检查使用情况在内的医疗保健利用指标，并使用调整了社会人口统计学因素和合并症的回归模型比较了男性和女性患者之间的差异。结果以女性患者与男性患者相比的比值比（OR）及其 95%置信区间（CI）报告。
共分析了 41277 例 RA 患者（69%为女性）、8150 例 AS 患者（51%为女性）和 6446 例 PsA 患者（54%为女性）。在所有三个队列中都观察到了类似的性别差异趋势。在诊断前，女性患者更可能因肌肉骨骼原因就诊于风湿病学家（OR 1.32-2.28）和家庭医生（OR 1.03-1.15），而男性患者更可能因肌肉骨骼原因就诊于急诊（OR 0.76-0.87）。在诊断前，女性患者也更可能进行肌肉骨骼影像学和实验室检查。诊断后，女性患者更可能继续接受风湿病学治疗（OR 1.12-1.24）。
患有 IA 的女性患者的医疗保健利用率高于男性患者，这可能表明疾病过程中的生物学差异或寻求医疗保健行为中的社会文化差异。
