From the Department of Orthopaedic Surgery (Ortiz-Babilonia, Mo, Raad, Ficke, Jain), Johns Hopkins University, Baltimore, MD; and Department of Orthopaedic Surgery (Ortiz-Babilonia), University of Puerto Rico Medical Sciences Campus, San Juan, PR.
J Am Acad Orthop Surg. 2022 Sep 15;30(18):e1188-e1194. doi: 10.5435/JAAOS-D-22-00271. Epub 2022 Aug 9.
There is limited research on the supply and distribution of orthopaedic surgeons in the United States. The goal of this study was to analyze the association of orthopaedic surgeon distribution in the United States with geographic and sociodemographic factors.
County-level data from the US Department of Health and Human Services Area Health Resources Files were used to determine the density of orthopaedic surgeons across the United States on a county level. Data were examined from 2000 to 2019 to analyze trends over time. Bivariate and multivariable negative binomial regression models were constructed to identify county-level sociodemographic factors associated with orthopaedic surgeon density.
In 2019, 51% of the counties in the United States did not have an orthopaedic surgeon. Metropolitan counties had a mean of 22 orthopaedic surgeons per 100,000 persons while nonmetropolitan and rural counties had a mean of 2 and 0.1 orthopaedic surgeons per 100,000 persons, respectively. Over the past 2 decades, there was a significant increase in the percentage of orthopaedic surgeons in metropolitan counties (77% in 2000 vs 93% in 2019, P < 0.001) and in the proportion of orthopaedic surgeons 55 years and older (32% in 2000 vs 39% in 2019, P < 0.001). Orthopaedic surgeon density increased with increasing median home value (P < 0.001) and median household income (P < 0.001). Counties with a higher percentage of persons in poverty (P < 0.001) and higher unemployment rate (P < 0.001) and nonmetropolitan (P < 0.001) and rural (P < 0.001) counties had a lower density of orthopaedic surgeons. On multivariable analysis, a model consisting of median home value (P < 0.001), rural counties (P < 0.001), percentage of noninsured persons (P < 0.001), and percentage of foreign-born persons (P < 0.001) predicted orthopaedic surgeon density.
Access to orthopaedic surgeons in the United States in rural areas is decreasing over time. County-level socioeconomic factors such as wealth and urbanization were found to be closely related with surgeon density.
美国对矫形外科医生的供应和分布情况的研究有限。本研究的目的是分析美国矫形外科医生分布与地理和社会人口因素之间的关系。
使用美国卫生与公众服务部地区卫生资源档案中的县级数据，确定美国各县的矫形外科医生密度。分析了 2000 年至 2019 年的数据，以分析随时间的趋势。构建了双变量和多变量负二项回归模型，以确定与矫形外科医生密度相关的县级社会人口因素。
2019 年，美国有 51%的县没有矫形外科医生。大都市县每 10 万人中有 22 名矫形外科医生，而非大都市县和农村县每 10 万人中分别有 2 名和 0.1 名矫形外科医生。在过去的 20 年中，大都市县的矫形外科医生比例（2000 年为 77%，2019 年为 93%，P < 0.001）和 55 岁及以上的矫形外科医生比例（2000 年为 32%，2019 年为 39%，P < 0.001）均显著增加。矫形外科医生的密度随着中位数家庭价值（P < 0.001）和中位数家庭收入（P < 0.001）的增加而增加。贫困人口比例较高（P < 0.001）、失业率较高（P < 0.001）、非大都市（P < 0.001）和农村（P < 0.001）的县的矫形外科医生密度较低。多变量分析显示，由中位数家庭价值（P < 0.001）、农村县（P < 0.001）、未参保人数百分比（P < 0.001）和外国出生人数百分比（P < 0.001）组成的模型可预测矫形外科医生的密度。
美国农村地区获得矫形外科医生的机会正在减少。发现县级社会经济因素（如财富和城市化）与外科医生密度密切相关。
