The effect of education and income on need and willingness to undergo total joint arthroplasty
The effect of education and income on need and willingness to undergo total joint arthroplasty
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DOI：
10.1002/art.10682
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发表时间：
2002-12-01
影响因子：
--
通讯作者：
Badley, EA
中科院分区：
文献类型：
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作者：
Hawker, GA;Wright, JG;Badley, EA
Objective.社会经济地位（SES）较低的人接受关节炎护理较少，包括关节成形术。然而，没有研究考虑到患者的期望或需求。我们的目的是评估教育和收入对髋关节和膝关节置换术的潜在需求和意愿的影响。通过对居住在加拿大安大略2个地区的48，218名年龄在55岁或以上的人进行邮件/电话调查，确定了3，307名中度至重度髋关节/膝关节问题的个体。这些人接受了一份问卷调查，以评估教育，收入，关节炎的严重程度，和合并症。在这些受试者的一个子集中，我们进行了访谈，以评估考虑关节成形术的意愿，我们还进行了关节的临床和放射学检查，以验证关节炎的自我报告。关节置换术的潜在需求被定义为存在严重关节炎（根据西安大略和麦克马斯特大学骨关节炎指数评分），没有绝对的手术禁忌症。在控制年龄、性别和居住地区后，独立的逻辑回归模型检查了教育和收入对关节置换术的潜在需求和明确意愿的独立影响。潜在的未满足需求被估计为需要关节成形术的受试者的比例，这些受试者没有在手术等待名单上，他们肯定愿意考虑关节成形术，并且通过检查和X线片有关节炎的证据。所有问卷和访谈的回复率至少为72%。受教育程度较低（高中以下与中学后教育的调整优势比[OR] 1.57，95%置信区间[95% CI] 1.17-2.11）和收入较低（收入低于或等于20，000美元与> 40，000美元的调整优势比1.83，95% CI 1.24-2.70）与更大的可能性独立相关。可能需要关节成形术。在有潜在需求的受试者中，教育程度和收入均与考虑关节成形术的明确意愿无关。因此，考虑到意愿，教育程度低和/或收入低的个体更有可能对关节成形术有潜在的未满足的需求。与SES较高的患者相比，SES较低的患者对关节成形术的需求更大，并且同样愿意考虑关节成形术。因此，所观察到的SES在关节成形术率方面的差异不能用SES较低的患者接受关节成形术的需求较低或意愿较低来解释。
Objective. Individuals with lower socioeconomic status (SES) receive less arthritis care, including joint arthroplasty. However, no studies have considered the expectations or needs of the patients. Our objective was to assess the effect of education and income on the potential need for, and the willingness to consider hip and knee arthroplasty.Methods. Through a mail/telephone survey of 48,218 persons ages 55 years or older residing in 2 areas of Ontario, Canada, 3,307 individuals with moderate-to-severe hip/knee problems were identified. These individuals received a questionnaire to assess education, income, arthritis severity, and comorbidity. In a subset of these subjects, we conducted interviews to evaluate the willingness to consider arthroplasty, and we also performed clinical and radiographic examinations of the joints to validate self-reports of arthritis. The potential need for arthroplasty was defined as the presence of severe arthritis (as scored by the Western Ontario and McMaster Universities Osteoarthritis Index), with no absolute contraindications to surgery. Separate logistic regression models examined the independent effects of education and income on the potential need for, and definite willingness to consider arthroplasty, after controlling for age, sex, and region of residence. Potential unmet need was estimated as the proportion of subjects with the need for arthroplasty who were not already on a surgery waiting list, who were definitely willing to consider arthroplasty, and who had evidence of arthritis by examination and radiography.Results. Response rates were at least 72% for all questionnaires and interviews. Less education (adjusted odds ratio [OR] 1.57 for less than high school versus postsecondary education, 95% confidence interval [95% CI] 1.17-2.11) and lower income (adjusted OR 1.83 for less than or equal to$20,000 versus >$40,000, 95% CI 1.24-2.70) were independently associated with a greater likelihood of. having the potential need for arthroplasty. Among the subjects' with potential need, neither education nor income was independently associated with a definite willingness to consider arthroplasty. Thus, taking willingness into consideration, individuals with less education and/or lower income were more likely to have potential unmet need for arthroplasty.Conclusion. Persons with lower SES had a greater need for, and were equally willing to consider arthroplasty, compared with those with higher SES. Thus, observed SES disparities in the rates of performed arthroplasties cannot be explained by a lower need or less willingness to undergo arthroplasty in those with lower SES.