Impact of the Economic Downturn on Total Joint Replacement Demand in the United States
Impact of the Economic Downturn on Total Joint Replacement Demand in the United States
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DOI：
10.2106/jbjs.m.00285
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发表时间：
2014-04-16
影响因子：
5.3
通讯作者：
Bozic, Kevin J.
中科院分区：
文献类型：
--
作者：
Kurtz, Steven M.;Ong, Kevin L.;Bozic, Kevin J.
背景：很少有研究探讨国家卫生支出和宏观经济对全关节置换术使用的影响。经济低迷引发了人们对未来全关节置换增长可持续性的质疑。以前对美国关节置换术总需求的预测是基于2003年的数据，使用的统计方法忽略了宏观经济因素，如国家卫生支出。方法：使用来自全国住院患者样本(1993-2010年)的数据和美国人口普查和国家卫生支出数据来量化总关节置换率的历史趋势，包括本世纪头十年的两次经济衰退。使用国际疾病分类，第九次修订，临床修改中的代码识别初次和翻修的髋关节和膝关节置换术。使用回归模型估计了关节置换总量的预测，该回归模型将1993年至2010年的人口增长和关节成形率作为年龄、性别、种族和人口普查地区的函数，并使用国家卫生支出作为自变量。回归模型与政府对2011年至2021年国家卫生支出的预测结合使用，以估计美国亚群中未来的关节成形率，并得出全国估计。结果：关节成形术发病率的增长趋势，对于美国总人口和美国劳动力来说，对经济衰退不敏感。从2009年到2010年，初次全髋关节置换术的手术总数增加了6.0%，初次全膝关节置换术增加了6.1%，翻修全髋关节置换术增加了10.8%，翻修全膝关节置换术增加了13.5%。美国国家卫生支出模型对2020年初次髋关节置换的预测高于之前的预测模型，而当前模型对全膝关节置换的预测较低。结论：本世纪头十年的经济低迷并未对美国全国髋关节和膝关节置换的增长趋势产生实质性影响。这些最新的预测为外科医生、医院、支付者和政策制定者规划未来全关节置换手术的需求提供了基础。
Background: Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure.Methods: Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates.Results: The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower.Conclusions: Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.