Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7: Australian Orthopaedic Association National Joint Replacement Registry.

Sharon L Brennan,Julie A Pasco,Geoffrey C Nicholson,Richard S Page,Margaret J Henry,Mark A Kotowicz,Anita E Wluka,Stephen E Graves,Tyman Stanford

doi:10.1186/1471-2474-13-63

Abstract

BackgroundThe utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia.MethodsUsing the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk.ResultsFemales accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups.ConclusionsFurther work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Highlights

The utilization of total hip replacement (THR) surgery is rapidly increasing, few data examine whether these procedures are associated with socioeconomic status (SES) within Australia
Variations in the utilization of Total hip replacement (THR) procedures have been reported across socioeconomic status (SES) in various countries such as England [4,5,6,7,8], USA [9], Italy [10], and other geographic regions [11,12,13,14,15], the latter has often been explained in relation to urban and rural distinctions, and as such suggested to be associated with access issues
Using a comprehensive registry of hip replacement surgeries across Australia, we focused on a representative region of broader Australia to assess the association between SES and utilization of THR in both males and females for the Barwon Statistical Division (BSD)

Summary

Introduction

The utilization of total hip replacement (THR) surgery is rapidly increasing, few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. Variations in the utilization of THR procedures have been reported across socioeconomic status (SES) in various countries such as England [4,5,6,7,8], USA [9], Italy [10], and other geographic regions [11,12,13,14,15], the latter has often been explained in relation to urban and rural distinctions, and as such suggested to be associated with access issues. A study that examined hospital separations for primary joint replacement surgeries identified a lower rate of THR for individuals residing in more socially disadvantaged areas of Australia [15]. Understanding the association between SES and THR utilization has an important implication for the promotion and allocation of health services resources across the social spectrum

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