Increase in Total Joint Arthroplasty Projected from 2014 to 2046 in Australia: A Conservative Local Model With International Implications
Increase in Total Joint Arthroplasty Projected from 2014 to 2046 in Australia: A Conservative Local Model With International Implications
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DOI：
10.1007/s11999-017-5377-7
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发表时间：
2017-08-01
影响因子：
4.2
通讯作者：
Nemes, Szilard
中科院分区：
文献类型：
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作者：
Inacio, Maria C. S.;Graves, Stephen E.;Nemes, Szilard
关节成形术的发病率在世界范围内不断增加。国际上对关节置换术未来需求的估计使用了一些模型，这些模型提出了未来的指数增长（尽管存在明显的系统限制）或静态增长（不考虑过去的趋势）。有必要针对过去预测的局限性提出针对具体国家的预测估计数。澳大利亚是一个高收入国家，在经济合作与发展组织（OECD）国家中TKA发生率排名第7，THA发生率排名第15，TKA和THA的数量增加了198%确定2014年至2046年澳大利亚40岁以上人群中初次TKA和THA的预计发生率和数量澳大利亚州和地区卫生部的数据用于识别1994年至1995年以及2013年至2014年期间进行的TKA和THA。澳大利亚统计局是同期人口估计数和2046年前人口预测估计数的来源。计算每10万名40岁以上澳大利亚公民中TKA和THA的发生率（IR）、95% CI和预测区间（PI）。使用逻辑模型估计未来的IR，并根据预计的IR和人群计算体积。logistic增长模型假设存在TKA和THA发生率的上限以及与该发生率直接相关的增长率。在开始时，当观察到的发病率远低于渐近线时，发病率呈指数增长，但当接近上限时，发病率下降。预计2013年至2046年间，澳大利亚的原发性THA的发病率将增加66（2013年：IR = 307/100，000，[95%CI，262-329/100，000]，而2046年：IR= 510/100，000，[95%PI，98-567/100，000]），这意味着在此期间的数量增加了219%。对于TKA，预计到2046年，IR将增加26%（IR = 575/100，000; 95% PI，402-717/100，000）与2013年相比（IR = 437/100 000; 95%CI，397-479/100，000），成交量增长142%使用保守的预测模型，考虑到澳大利亚过去的手术趋势和未来的人口变化，预计关节成形术的数量将大幅增加。这些调查结果具有国际影响，因为它们表明，使用针对具体国家的保守预测方法，预计这些程序的数量将大幅增加。关节成形术数量的增加需要适当的劳动力规划、资源分配和预算规划，以满足需求。
The incidence of joint arthroplasty is increasing worldwide. International estimates of future demand for joint arthroplasty have used models that propose either an exponential future increase, despite obvious system constraints, or static increases, which do not account for past trends. Country-specific projection estimates that address limitations of past projections are necessary. In Australia, a high-income country with the 7th highest incidence of TKA and 15th highest incidence of THA of the Organization for Economic Cooperation and Development (OECD) countries, the volume of TKAs and THAs increased 198% between 1994 and 2014.To determine the projected incidence and volume of primary TKAs and THAs from 2014 to 2046 in the Australian population older than 40 years.Australian State and Territory Health Department data were used to identify TKAs and THAs performed between 1994 and 1995 and 2013 and 2014. The Australian Bureau of Statistics was the source of the population estimates for the same periods and population-projected estimates until 2046. The incidence rate (IR), 95% CI, and prediction interval (PI) of TKAs and THAs per 100,000 Australian citizens older than 40 years were calculated. Future IRs were estimated using a logistic model, and volume was calculated from projected IR and population. The logistic growth model assumes the existence of an upper limit of the TKA and THA incidences and a growth rate directly related to this incidence. At the beginning, when the observed incidence is much lower than the asymptote, the increase is exponential, but it decreases as it approaches the upper limit.A 66% increase in the IR of primary THAs between 2013 and 2046 is projected for Australia (2013: IR = 307 per 100,000, [95% CI, 262-329 per 100,000] compared with 2046: IR= 510 per 100,000, [95% PI, 98-567 per 100,000]), which translates to a 219% increase in the volume during this period. For TKAs the IR is expected to increase by 26% by 2046 (IR = 575 per 100,000; 95% PI, 402-717 per 100,000) compared with 2013 (IR = 437 per 100,000; 95% CI, 397-479 per 100,000) and the volume to increase by 142%.A large increase in the volume of arthroplasties is expected using a conservative projection model that accounts for past surgical trends and future population changes in Australia. These findings have international implications, as they show that using country- specific, conservative projection approaches, a substantial increase in the number of these procedures is expected. This increase in joint arthroplasty volume will require appropriate workforce planning, resource allocation, and budget planning so that demand can be met.Level II, economic and decision analysis.