Albright J Alex, Lemme Nicholas J, Meghani Ozair, Owens Brett D
Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Orthop J Sports Med. 2023 Feb 17;11(2):23259671221147050. doi: 10.1177/23259671221147050. eCollection 2023 Feb.
Socioeconomic status has been shown to influence patients' ability to access health care.
To evaluate the socioeconomic status and/or insurance provider of patients and to determine whether these differences influence the management of shoulder instability.
Descriptive epidemiology study.
The Rhode Island All-Payers Claims Database (APCD) was used to identify all patients between the ages of 5 and 64 years who made an insurance claim related to a shoulder instability event between January 1, 2011, and December 31, 2019. Chi-square analysis and multivariate logistic regression were utilized to determine whether insurance status, social deprivation index (SDI), or median income by zip code were significant predictors of treatment methodology and recurrent instability. Kaplan-Meier failure analysis and Cox regression were used to assess for variation in the cumulative rates of surgical intervention and recurrent instability over 20-year age groups (5-24, 25-44, and 45-64 years).
There were 3310 patients from the APCD query included in the analysis. Bivariate analysis demonstrated significant variation in the rates of surgical stabilization between patients with public and commercial insurance providers ( < .001). Patients with public insurance received surgery 1.8% of the time compared with 5.8% of the time in patients with commercial insurance. After controlling for recurrent instability, age, instability type (subluxation or dislocation) and directionality, and sex, patients with public insurance were 79% less likely to receive surgery within 30 days ( = .035) and 64% less likely to receive surgery within 1 year ( = .002). This disparity was most notable in the 5- to 24-year (hazard ratio [HR] = 0.28; 95% CI, 0.13-0.61) and 25- to 44-year (HR = 0.26; 95% CI, 0.08-0.89) age groups. Neither SDI quartile nor income quartile based on patient primary zip code had a clinically significant influence on rates of surgery or recurrent instability.
These data demonstrate that patients with public insurance have a decreased likelihood of undergoing surgical stabilization to address glenohumeral instability compared with patients with commercial insurance.
社会经济地位已被证明会影响患者获得医疗保健的能力。
评估患者的社会经济地位和/或保险提供者，并确定这些差异是否会影响肩关节不稳定的治疗。
描述性流行病学研究。
使用罗德岛全付费者索赔数据库（APCD）来识别2011年1月1日至2019年12月31日期间所有年龄在5至64岁之间且提出与肩关节不稳定事件相关保险索赔的患者。采用卡方分析和多因素逻辑回归来确定保险状况、社会剥夺指数（SDI）或邮政编码中位数收入是否是治疗方法和复发性不稳定的重要预测因素。使用Kaplan-Meier失败分析和Cox回归来评估20年年龄组（5至24岁、25至44岁和45至64岁）手术干预累积率和复发性不稳定的差异。
分析纳入了来自APCD查询的3310名患者。双变量分析表明，公共保险提供者和商业保险提供者的患者之间手术稳定率存在显著差异（P <.001）。公共保险患者接受手术的比例为1.8%，而商业保险患者为5.8%。在控制复发性不稳定、年龄、不稳定类型（半脱位或脱位）、方向性和性别后，公共保险患者在30天内接受手术的可能性降低79%（P =.035），在1年内接受手术的可能性降低64%（P =.002）。这种差异在5至24岁（风险比[HR]=0.28；95%置信区间，0.13至0.61）和25至44岁（HR = 0.26；95%置信区间，0.08至0.89）年龄组最为明显。基于患者主要邮政编码的SDI四分位数或收入四分位数对手术率或复发性不稳定均无临床显著影响。
这些数据表明，与商业保险患者相比，公共保险患者接受手术稳定治疗以解决盂肱关节不稳定的可能性降低。
