Boddu Sayi P, Gill Vikram S, Haglin Jack M, Brinkman Joseph C, Deckey David G, Bingham Joshua S
Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Arthroplast Today. 2024 May 9;27:101353. doi: 10.1016/j.artd.2024.101353. eCollection 2024 Jun.
Social determinants of health are implicated in the experience of knee osteoarthritis, a key component of which is access to care and healthcare utilization. The objective of this study was to describe difficulties in access to care and healthcare utilization in the United States knee osteoarthritis population.
The publicly available All of Us Database was utilized to conduct a retrospective cohort study. Patients with a diagnosis of knee osteoarthritis were included and matched to a control group who did not have knee osteoarthritis. The association of knee osteoarthritis and patient-specific demographic features with self-reported domains of access to care was analyzed.
Among 15,718 patients with knee osteoarthritis, 27.6% reported delayed care (n = 4343), 25.6% reported inability to afford care (n = 4015), 12.8% reported skipped medications (n = 2011), and 1.6% reported not seeing a healthcare provider in over 1 year (n = 247). Patients with knee osteoarthritis were more likely to be unable to afford care (odds ratio 1.21, < .001) or skip medications (odds ratio 1.12, = .004) in comparison to matched patients without knee osteoarthritis. Among the knee osteoarthritis cohort, low income and nonheterosexual orientation were both associated with increased rates of delayed care and an inability to afford care.
Patients with knee osteoarthritis report significant challenges with delayed care, affordability of care, and medication adherence. Among patients with knee osteoarthritis, patients who are younger age, female sex, low-income, low-education, nonheterosexual orientation, or have poor physical and mental health are at increased risk of having decreased access to treatment.
健康的社会决定因素与膝关节骨关节炎的发病有关，其中一个关键因素是获得医疗服务的机会和医疗保健的利用情况。本研究的目的是描述美国膝关节骨关节炎患者在获得医疗服务和医疗保健利用方面所面临的困难。
利用公开可用的“我们所有人”数据库进行回顾性队列研究。纳入诊断为膝关节骨关节炎的患者，并与未患膝关节骨关节炎的对照组进行匹配。分析膝关节骨关节炎及患者特定人口统计学特征与自我报告的医疗服务获取领域之间的关联。
在15718例膝关节骨关节炎患者中，27.6%报告有延迟就医情况（n = 4343），25.6%报告无力支付医疗费用（n = 4015），12.8%报告漏服药物（n = 2011），1.6%报告超过1年未就医（n = 247）。与匹配的无膝关节骨关节炎患者相比，膝关节骨关节炎患者更有可能无力支付医疗费用（比值比1.21，P <.001）或漏服药物（比值比1.12，P =.004）。在膝关节骨关节炎队列中，低收入和非异性恋取向均与延迟就医率增加和无力支付医疗费用有关。
膝关节骨关节炎患者在延迟就医、医疗费用支付能力和药物依从性方面面临重大挑战。在膝关节骨关节炎患者中，年龄较小、女性、低收入、低教育水平、非异性恋取向或身心健康状况较差的患者获得治疗的机会减少的风险增加。
