Racial disparities in joint replacement use among older adults
Racial disparities in joint replacement use among older adults
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DOI：
10.1097/00005650-200302000-00010
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发表时间：
2003-02-01
期刊：
影响因子：
3
通讯作者：
Chang, RW
中科院分区：
文献类型：
--
作者：
Dunlop, DD;Song, J;Chang, RW
背景。虽然关节置换术可以恢复严重关节疾病的关节炎患者的功能，但这种手术并没有在不同种族群体中得到平等的应用。通过全国样本评估关节置换术使用的差异。本研究评估了健康状况和经济条件的作用，以解释老年黑人和西班牙裔少数民族相对于白人在关节置换术方面的差异。纵向（1993-1995）老年人资产与健康动态（AHEAD）研究。背景。美国社区居住老年人的全国概率样本。病人的人口。受试者（n = 6159）年龄在69至103岁之间。结果是受试者报告2年内使用任何关节炎相关的关节置换术。自变量为人口统计、健康需求（关节炎、其他医疗条件、功能性健康）和经济途径（收入、资产、教育和健康保险）。与白人（每年1.48%）相比，老年少数民族报告与关节炎相关的关节置换术（黑人：0.98%；西班牙裔：0.97%）的频率较低。与白人相比，年龄较大的少数族裔使用关节置换术的可能性显著降低（OR, 0.37; 95% CI, 0.20, 0.71），控制了人口统计学、关节炎和其他健康需求。在额外控制经济医疗获取后，差异仍然显著（OR, 0.46; 95% CI, 0.22, 0.98）。单纯依赖医疗保险的人群与补充医疗保险的人群相比，使用医疗保险的比例更低（OR, 0.46; 95% CI, 0.22, 0.95）。这些国家数据表明，与黑人相比，西班牙裔老年人患关节炎相关关节置换术的比例较低。与白人相比，老年少数民族的使用率较低，这不能用健康需求或经济机会的差异来解释。其他文化和态度因素值得调查，以解释差异。
BACKGROUND. Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.OBJECTIVE. This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.DESIGN. Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.SETTING. National probability sample of US community-dwelling older adults.PATIENT POPULATION. AHEAD participants (n = 6159) aged 69 to 103 years.MEASUREMENTS. The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).RESULTS. Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).CONCLUSIONS. These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.