| 1. |
- Marcano, Alejandro I., et al.
(författare)
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Income change after cruciate ligament injury - A population-based study
- 2019
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Ingår i: Knee (Oxford). - : Elsevier BV. - 0968-0160 .- 1873-5800. ; 26:3, s. 603-611
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the association between choice of treatment and patients' income after cruciate ligament (CL) injury and assess the effect of different covariates such as sex, age, comorbidities and type of work.Methods: This entire-population cohort study in Sweden included working patients with a diagnosed CL injury between 2002 and 2005, identified in The National Swedish Patient Register (n = 13,662). The exposure was the treatment choice (operative or non-operative treatment). The main outcome measure was average yearly income five years after CL diagnosis, adjusted for the following covariates: sex, age, comorbidities, type of work, region, calendar year, education and income.Results: Relative to non-operative treatment, operative treatment was associated with greater average yearly incomes (nine to 15%) after injury among patients between 20 and 50 years, patients with partial university education, patients living in large cities and patients with one comorbidity, despite no overall significant association in the national cohort. Delayed operative treatment (>1 year) had no significant association with income change, whereas early operative treatment (<1 year) was associated with higher average yearly incomes (11 to 16%) among females, patients between 20 and 50 years, patients living in large cities and patients with one comorbidity.Conclusions: In a broad sense, treatment choice was not associated with changes in income five years after CL injuries among patients in the workforce, however earlier operative treatment was associated with higher average incomes among patients with ages between 20 and 50, females, living in large cities, with one comorbidity and with a high level of education.
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| 2. |
- Nordenvall, Richard
(författare)
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Cruciate ligament injury : crunching the numbers
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cruciate Ligament (CL) injury is a serious injury that occurs primarily during activities like soccer, handball, floorball, alpine skiing, etc. Patients are generally young and the injury often results in early discontinuation of activity and an early onset of osteoarthritis (OA). The optimal treatment of CL injury is under continuous debate, where surgical reconstruction is recommended for patients engaged in high-level sports. Non-surgical treatment is considered to have a satisfactory outcome in the general population. CL injuries are one of the most studied topics within the field of sports medicine. Over 20,000 articles have been published, however none of these studies have hitherto used a national register-based approach. The overall aim of this thesis was to study the incidence, treatment and long-term effects of patients with CL injury in Sweden using a register-based approach. The thesis includes four studies, each with a specific aim. The first aim was to calculate the incidence of CL injuries in the general population. Earlier studies have focused on patients at risk or on the reported cases in a smaller geographical setting. Thus, the incidence in the general population has been unknown. For a long time, an argument for CL reconstruction (CL-R) has been that it prevents development of post traumatic OA, however, studies investigating this have presented conflicting results. Therefore, the second aim of this thesis was to study if this argument could be proven using a register-based approach. The third aim was to study what impact socioeconomic status (SES) has on the choice of treatment for these injuries. For other conditions, higher SES has been associated with a higher access to and utilization of surgical treatments, but its effect on patients with CL injury has never been studied. The fourth aim was to study how choice of treatment for a CL injury influenced changes in SES. This approach to create a new alternative outcome for symptomatic surgical procedures is essential in the process to develop new tools and methods for personalized medicine. This thesis shows that the incidence of CL injury in Sweden is 78 per 100,000 inhabitants. More than 50% of the patients are younger than 30 years and 60% are males. Overall, 36% are treated with surgical reconstruction and this option was more common among younger patients. Preventing post-traumatic OA is not a valid argument for CL-R. On the contrary patients going through surgical reconstruction had a 22% increased risk of developing symptomatic OA compared with those treated non-operatively. Ten percent of the patients developed symptomatic OA, and a concomitant meniscus injury increased this risk threefold. Even though CL-R is done with the aim to create a stable knee, SES had a big impact on which treatment the patient was admitted to. Patients with university education had a 29% increased likelihood of undergoing CL-R compared with those who had not graduated from high-school. The choice of treatment did not significantly affect the salary of a patient five years after injury. However, this thesis presents a multivariate model for an alternative outcome for symptomatic surgery where individual variables, such as socioeconomic outcome variables, are considered. This sets the foundation for future studies about symptomatic surgery, and the creation of decision tools to offer a more personalized treatment.
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| 3. |
- Nordenvall, Richard, et al.
(författare)
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The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee : A Population-Based Cohort Study
- 2017
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Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 45:3, s. 535-540
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Tidskriftsartikel (refereegranskat)abstract
- Background:The socioeconomic status (SES) of patients has been widely recognized as playing an important role in many health-related conditions, including orthopaedic conditions, in which a higher SES has been associated with a higher utilization of more advanced medical treatments such as drugs, diagnostics, and surgery. However, the association between SES and cruciate ligament surgery has not been thoroughly investigated.Purpose:To evaluate the association between SES and choice of treatment in patients with a cruciate ligament injury.Study Design:Cohort study; Level of evidence, 3.Methods:All Swedish patients with a diagnosed cruciate ligament injury between 1987 and 2010 were identified from the Swedish National Patient Register (N = 98,349). The Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA) provided information on household income and highest achieved educational level, which were used as socioeconomic indices. The exposure was the SES of patients as determined by the household income and educational level, and the main outcome measure was treatment choice (surgical reconstruction vs nonoperative treatment). Poisson regression models estimated the association.Results:A total of 52,566 patients were included in the study; of these, 20,660 (39%) were treated operatively. Patients in the highest quartile of household income had a significantly higher likelihood of undergoing surgery than those in the lowest quartile (relative risk [RR], 1.16; 95% CI, 1.11-1.20). Patients classified as highly educated had a significantly increased likelihood of being treated operatively compared with those with a low education (RR, 1.29; 95% CI, 1.19-1.39).Conclusion:This study provides a population-based validation that having a higher SES as determined by the household income and/or level of education increases the likelihood of undergoing operative treatment after a cruciate ligament injury.Clinical Relevance:All Swedish citizens are entitled by law to the same quality of health care; therefore, unmotivated differences in treatment between different socioeconomic groups are to be seen as a challenge. It is important to evaluate the specific mechanisms by which the patient's SES influences the decision of whether to treat a cruciate ligament injury operatively.
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