理解单一支付者健康保险对全髋关节置换术（THA）利用中社会经济差异的影响：跨国分析。
Understanding the Influence of Single Payer Health Insurance on Socioeconomic Disparities in Total Hip Arthroplasty (THA) Utilization: A Transnational Analysis.
机构信息
From the Department of Medicine, Hospital for Special Surgery, New York, NY (Mehta, Goodman, and Parks), the Department of Medicine, Weill Cornell Medicine, New York, NY (Mehta, Ho, Goodman, Parks, and Wang), the Columbia University Vagelos College of Physicians & Surgeons, New York, NY (Gibbons), the Ontario Institute for Cancer Research, Toronto, ON (Ling), the Sunnybrook Health Sciences Centre, Toronto, ON (Ravi), the Northwell Health, New York, NY (Ibrahim), the The University of Texas Medical Branch, Galveston, TX (Cram), and the Faculty of Medicine, University of Toronto, Toronto, ON (Cram).
出版信息
J Am Acad Orthop Surg. 2024 Oct 15;32(20):955-963. doi: 10.5435/JAAOS-D-23-01178. Epub 2024 May 3.
OBJECTIVE
Access to care varies between countries. It is theorized that income-based disparities in access may be reduced in countries with universal health insurance relative to the United States, but data are currently limited. We hypothesized that income-based differences in total hip arthroplasty (THA) utilization and outcomes would be larger in the United States than in Canada.
METHODS
We retrospectively compared all patients undergoing THA from 2012 to 2018 in Pennsylvania, the United States, and Ontario, Canada. We compared age-standardized and sex-standardized per-capita THA utilization in the United States and Canada overall and across different income strata, where income strata were defined by neighborhood income quintile. We also examined income-based differences in rates of 1-year revision, 90-day mortality, and 90-day readmission.
RESULTS
Overall THA utilization per 10,000 people per year was higher across all income groups in Pennsylvania compared with Ontario (15.1 versus 8.8, P < 0.001 in lowest-income quintile; 21.4 versus 12.6, P < 0.001 in highest-income quintile). Income-based differences in utilization in the highest-income vs lowest-income quintile groups were greater in Ontario (43.2%) than Pennsylvania (41.7%). The adjusted odds for the lowest-income group compared with the highest-income group of 1-year revision were greater in Ontario compared with Pennsylvania ( P = 0.03), and risk of 90-day mortality and 90-day readmission was similar between the regions.
CONCLUSION
Income-based differences in THA utilization were more notable in Ontario than in Pennsylvania. In addition, patients in low-income communities in Ontario were at equal or greater risk relative to high-income community patients for adverse outcomes compared with patients in Pennsylvania. Income-based disparities in THA utilization and outcomes were smaller in the United States than in Canada, in contrast to what might be expected.
LEVEL OF EVIDENCE
III.
目的
不同国家之间的医疗服务可及性存在差异。理论上，相对于美国，具有全民医疗保险的国家可能会减少因收入差异导致的医疗服务可及性差异，但目前数据有限。我们假设，在美国，基于收入的全髋关节置换术（THA）利用率和结果的差异会比在加拿大更大。
方法
我们回顾性比较了 2012 年至 2018 年在美国宾夕法尼亚州和加拿大安大略省接受 THA 的所有患者。我们比较了美国和加拿大总体以及不同收入阶层的标准化年龄和性别后每 10000 人每年的 THA 利用率，其中收入阶层是根据社区收入五分位数定义的。我们还研究了基于收入的 1 年翻修率、90 天死亡率和 90 天再入院率的差异。
结果
宾夕法尼亚州所有收入群体的每 10000 人每年 THA 利用率均高于安大略省（最低收入五分位数组为 15.1 比 8.8，P < 0.001；最高收入五分位数组为 21.4 比 12.6，P < 0.001）。在收入最高和最低五分位组中，安大略省的利用差异大于宾夕法尼亚州（43.2%比 41.7%）。与宾夕法尼亚州相比，安大略省最低收入组与最高收入组相比，1 年翻修的调整比值比更高（P = 0.03），且两个地区的 90 天死亡率和 90 天再入院率相似。
结论
安大略省 THA 利用率的差异比宾夕法尼亚州更为显著。此外，与宾夕法尼亚州相比，安大略省低收入社区的患者在不良结果方面的风险与高收入社区患者相等或更高，而在加拿大，基于收入的 THA 利用率和结果的差异小于美国。这与预期相反。
证据水平
III。
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