Wilson M G, May D S, Kelly J J
Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Ethn Dis. 1994 Winter;4(1):57-67.
The purpose of this study was to determine differences in the use of total knee arthroplasty for osteoarthritis among black and white older Americans and to determine whether clinical and economic factors contribute to these differences. Data on black and white Americans aged 65 years and older were gleaned from national Medicare hospitalization records for 1980 through 1988 and the Medicare enrollment file for 1987, the First National Health and Nutrition Examination Survey of 1971 through 1975, the National Hospital Discharge Survey of 1979 through 1988, the 1980 through 1988 US census counts and estimates, and 1980 census economic data. Information gathered includes prevalence of osteoarthritis of the knee among blacks and whites; rate of total knee arthroplasty use in the United States by race, sex, and age of subjects at the time of operations; use of competing procedures; and economic factors. Results showed that blacks were less often treated with total knee arthroplasty than were whites (white-to-black rate ratios = 3.0 to 5.1 for men and 1.5 to 2.0 for women) but had nonsignificantly higher rates of clinical osteoarthritis of the knee (white-to-black rate ratios = 0.39 for men and 0.78 for women). This racial difference in total knee arthroplasty rates was consistent across income levels and was unexplained by black patients' having operations at earlier ages or using competing procedures. Furthermore, the discrepancy occurred even among Medicaid-eligible Medicare recipients, who had no direct economic disincentive for surgery. These findings suggest that even though elderly blacks have higher rates of knee osteoarthritis, they do not receive total knee arthroplasty as often as do elderly whites. This discrepancy does not appear to have an economic explanation. Even if a comprehensive care system were in place to remove economic barriers, inequality in the use of this procedure would likely persist. Future studies should assess the nonclinical and noneconomic causes of these differences.
本研究的目的是确定美国黑人和白人老年患者在因骨关节炎接受全膝关节置换术方面的差异，并确定临床和经济因素是否导致了这些差异。1980年至1988年全国医疗保险住院记录、1987年医疗保险参保档案、1971年至1975年首次全国健康和营养检查调查、1979年至1988年全国医院出院调查、1980年至1988年美国人口普查计数和估计数据以及1980年人口普查经济数据中收集了65岁及以上美国黑人和白人的数据。收集的信息包括黑人和白人膝关节骨关节炎的患病率；美国按种族、性别和手术时患者年龄划分的全膝关节置换术使用率；替代手术的使用情况；以及经济因素。结果显示，黑人接受全膝关节置换术的频率低于白人（男性白人与黑人的比率为3.0至5.1，女性为1.5至2.0），但膝关节临床骨关节炎的发生率略高于白人（男性白人与黑人的比率为0.39，女性为0.78）。全膝关节置换术率的这种种族差异在不同收入水平上是一致的，并且不能用黑人患者手术年龄较早或使用替代手术来解释。此外，这种差异甚至在符合医疗补助条件的医疗保险受益人中也存在，他们没有手术的直接经济阻碍。这些发现表明，尽管老年黑人膝关节骨关节炎的发生率较高，但他们接受全膝关节置换术的频率不如老年白人。这种差异似乎没有经济方面的解释。即使建立了一个全面的护理系统来消除经济障碍，该手术使用方面的不平等可能仍然会持续。未来的研究应该评估这些差异的非临床和非经济原因。
