Hinman Adrian, Chang Richard, Royse Kathryn E, Navarro Ronald, Paxton Elizabeth, Okike Kanu
Department of Orthopaedics, The Permanente Medical Group, San Leandro, California.
Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, California.
J Arthroplasty. 2023 Dec;38(12):2541-2548. doi: 10.1016/j.arth.2023.08.030. Epub 2023 Aug 17.
Utilization of total joint arthroplasty (TJA) is affected by differences linked to sex, race, and socioeconomic status; there is little information about how geographic variation contributes to these differences. We sought to determine whether discrepancies in TJA utilization exist in patients diagnosed with osteoarthritis (OA) based upon urban-rural designation in a universal coverage system.
We conducted a cohort study using data from a US-integrated healthcare system (2015 to 2019). Patients aged ≥50 years who had a diagnosis of hip or knee OA were included. Total hip arthroplasty and total knee arthroplasty utilization (in respective OA cohorts) was evaluated by urban-rural designation (urban, mid, and rural). Incidence rate ratios (IRRs) for urban-rural regions were modeled using multivariable Poisson regressions.
The study cohort included 93,642 patients who have hip OA and 275,967 patients who had knee OA. In adjusted analysis, utilization of primary total hip arthroplasty was lower in patients living in urban areas (IRR = 0.87, 95% confidence interval = 0.81 to 0.94) compared to patients in rural regions. Similarly, total knee arthroplasty was used at a lower rate in urban areas (IRR = 0.88, 95% confidence interval = 0.82 to 0.95) compared with rural regions. We found no differences in the hip and knee groups within the mid-region.
In hip and knee OA patients enrolled in a universal coverage system, we found patients living in urban areas had lower TJA utilization compared to patients living in rural areas. Further research is needed to determine how patient location contributes to differences in elective TJA utilization.
III.
全关节置换术（TJA）的使用受到与性别、种族和社会经济地位相关差异的影响；关于地理差异如何导致这些差异的信息很少。我们试图确定在全民医保体系中，根据城乡划分，被诊断为骨关节炎（OA）的患者在TJA使用方面是否存在差异。
我们使用美国综合医疗系统（2015年至2019年）的数据进行了一项队列研究。纳入年龄≥50岁且诊断为髋或膝OA的患者。通过城乡划分（城市、中部和农村）评估全髋关节置换术和全膝关节置换术的使用情况（在各自的OA队列中）。使用多变量泊松回归对城乡地区的发病率比（IRR）进行建模。
研究队列包括93642例髋OA患者和275967例膝OA患者。在调整分析中，与农村地区的患者相比，城市地区的患者初次全髋关节置换术的使用率较低（IRR = 0.87，95%置信区间 = 0.81至0.94）。同样，与农村地区相比，城市地区全膝关节置换术的使用率较低（IRR = 0.88，95%置信区间 = 0.82至0.95）。我们发现中部地区的髋部和膝部组之间没有差异。
在参加全民医保体系的髋和膝OA患者中，我们发现城市地区的患者与农村地区的患者相比，TJA使用率较低。需要进一步研究以确定患者所在位置如何导致择期TJA使用的差异。
III级。
