Imbalance of Prevalence and Specialty Care for Osteoarthritis for First Nations People in Alberta, Canada
Imbalance of Prevalence and Specialty Care for Osteoarthritis for First Nations People in Alberta, Canada
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DOI：
10.3899/jrheum.140551
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发表时间：
2015-02-01
影响因子：
3.9
通讯作者：
Marshall, Deborah A.
中科院分区：
文献类型：
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作者：
Barnabe, Cheryl;Hemmelgarn, Brenda;Marshall, Deborah A.
目标。评估加拿大艾伯塔省原住民(FN)和非原住民(Non-FN)对骨关节炎(OA)的人群患病率和医疗保健使用情况。一组患有骨性关节炎的成年人(=两年内2名医生索赔或1名住院治疗，ICD-9-临床修改代码715x或ICD-10-加拿大适应代码M15-19,1993-2010)被定义为按保费支付者状态确定FN。流行率(2007/8)是根据队列和艾伯塔省医疗保险计划登记的人口估计的。评估门诊初级保健和专科就诊(骨科、风湿科、内科)、关节置换术(髋关节和膝关节)和各种原因住院的比率。FN人群的骨性关节炎患病率是非FN人群的两倍[16.1比7.8例/100人口，调整了年龄和性别的标准化比率比(SRR)2.06，95%可信区间2.00~2.12]。与非FN组相比，FN组OA患者的初级保健就诊SRR(调整了年龄、性别和居住地点)几乎翻了一番(SRR1.88，95%可信区间1.87~1.89)，内科就诊增加(SRR1.25，95%可信区间1.25~1.26)。骨科医生(SRR 0.49，95%CI 0.48-0.50)或风湿科医生(SRR 0.62，95%CI 0.62-0.63)的就诊率在FN合并OA患者中显著较低。股骨头坏死合并骨性关节炎患者接受髋关节和膝关节置换术的频率较低(SRR为0.48，95%CI为0.47~0.49)，但全因住院率较高(SRR为1.59，95%CI为1.58~1.60)。我们估计，在不同医疗保健用途的FN人群中，OA的患病率要高出2倍。与普通人群相比，初级保健使用率较高而专科服务和关节置换术使用率较低的原因尚不清楚。
Objective. To estimate the population-based prevalence and healthcare use for osteoarthritis (OA) by First Nations (FN) and non-First Nations (non-FN) in Alberta, Canada.Methods. A cohort of adults with OA (= 2 physician claims in 2 yrs or 1 hospitalization with ICD-9-Clinical Modification code 715x or ICD-10-Canadian Adaptation code M15-19, 1993-2010) was defined with FN determination by premium payer status. Prevalence rates (2007/8) were estimated from the cohort and the population registered with the Alberta Health Care Insurance Plan. Rates of outpatient primary care and specialist visits (orthopedics, rheumatology, internal medicine), arthroplasty (hip and knee), and all-cause hospitalization were estimated.Results. OA prevalence in FN was twice that of the non-FN population [16.1 vs 7.8 cases/100 population, standardized rate ratio (SRR) adjusted for age and sex 2.06, 95% CI 2.00-2.12]. The SRR (adjusted for age, sex, and location of residence) for primary care visits for OA was nearly double in FN compared with non-FN (SRR 1.88, 95% CI 1.87-1.89), and internal medicine visits were increased (SRR 1.25, 95% CI 1.25-1.26). Visit rates with an orthopedic surgeon (SRR 0.49, 95% CI 0.48-0.50) or rheumatologist (SRR 0.62, 95% CI 0.62-0.63) were substantially lower in FN with OA. Hip and knee arthroplasties were performed less frequently in FN with OA (SRR 0.48, 95% CI 0.47-0.49), but all-cause hospitalization rates were higher (SRR 1.59, 95% CI 1.58-1.60).Conclusion. We estimate a 2-fold higher prevalence of OA in the FN population with differential healthcare use. Reasons for higher use of primary care and lower use of specialty services and arthroplasty compared with the general population are not yet understood.