Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
BMC Musculoskelet Disord. 2023 Sep 12;24(1):726. doi: 10.1186/s12891-023-06820-0.
Few reports have examined the localized regional disparity in representative surgical procedures in orthopaedics and general surgery globally. This study aimed to clarify the inter-prefectural regional disparity and relationships between healthcare resources and representative surgical procedures using a nationwide database in Japan.
The number of medical specialists in orthopaedics, general surgery, and anaesthesiology, as well as the number of hospitals, and the incidence of representative surgical procedures in orthopaedics and general surgery were evaluated annually per 100,000 inhabitants/people by prefecture in Japan during 2015-2019. Medium-sized regional disparities were evaluated using the Gini coefficient. Correlation coefficients were calculated for the defined variables and ageing rate. We also compared the urban and rural regional disparities in all study variables.
The annual average number/incidence and Gini coefficients were 110.6 and 0.11 for femur fracture surgery, 106.3 and 0.09 for cholecystectomy, 14.2 and 0.11 for orthopaedic surgeon specialists, 17.6 and 0.09 for general surgeon specialists, 5.9 and 0.13 for anaesthesiology specialists, and 8.1 and 0.21 for hospitals, respectively. The correlation coefficients by the incidence of femur fracture surgery were 0.74 for orthopaedic surgeon specialists (p < 0.001), 0.63 for hospitals (p < 0.001), and 0.62 for the ageing rate (p < 0.001); those by the incidence of cholecystectomy were 0.60 for general surgeon specialists (p < 0.001) and 0.59 for hospitals (p < 0.001). The number/incidence of orthopaedic surgeon specialists, hospitals, femur fracture surgery, and cholecystectomy, as well as the ageing rate, were significantly higher in rural prefectures than in urban prefectures (p < 0.05).
Inter-prefectural regional disparity was small, although certain items were unevenly distributed in the rural prefectures, which is contrary to our expectations. Higher prevalence was recognised in rural prefectures due to the higher ageing rate; however, supply and demand are balanced. This study provides basic data for healthcare policy development in a medium-sized community.
III.
很少有报告检查过全球骨科和普通外科代表性手术的局部区域差异。本研究旨在使用日本全国数据库阐明医疗资源与代表性手术之间的地区间差异和关系。
2015 年至 2019 年，按每 10 万居民/人口评估日本各地区骨科和普通外科的骨科专家、普通外科专家和麻醉师人数、医院数量以及骨科和普通外科的代表性手术发生率。使用基尼系数评估中等区域差异。计算了定义变量和老龄化率之间的相关系数。我们还比较了所有研究变量的城乡区域差异。
股骨骨折手术的年平均数量/发生率和基尼系数分别为 110.6 和 0.11，胆囊切除术分别为 106.3 和 0.09，骨科专家分别为 14.2 和 0.11，普通外科专家分别为 17.6 和 0.09，麻醉师专家分别为 5.9 和 0.13，医院分别为 8.1 和 0.21。股骨骨折手术发生率的相关系数分别为骨科专家 0.74（p<0.001），医院 0.63（p<0.001）和老龄化率 0.62（p<0.001）；胆囊切除术的发生率分别为普通外科专家 0.60（p<0.001）和医院 0.59（p<0.001）。骨科专家数量/发生率、医院、股骨骨折手术和胆囊切除术以及老龄化率在农村县明显高于城市县（p<0.05）。
尽管农村县的某些项目分布不均，但地区间的区域差异较小，这与我们的预期相反。由于老龄化率较高，农村县的发病率较高；但是供需平衡。本研究为中型社区的医疗保健政策制定提供了基础数据。
III 级。
