Abstract
Summary
Compared to urban residents, those in rural/regional areas often experience inequitable healthcare from specialist service providers. Independent of small between-area differences in utilisation, socially advantaged groups had the greatest uptake of joint replacement. These data suggest low correlation between ‘need’ vs. ‘uptake’ of surgery in rural/regional areas.
Background and purpose
Compared to urban residents, those in rural and regional areas often experience inequitable healthcare from specialist service providers, often due to geographical issues. We investigated associations between socioeconomic position (SEP), region of residence and utilisation of primary total knee replacement (TKR) and/or total hip replacement (THR) for osteoarthritis.
Design and methods
As part of the Ageing, Chronic Disease and Injury study, we extracted data from the Australian Orthopaedic Association National Joint Replacement Registry (2011–2013) for adults that utilised primary TKR (n = 4179; 56% female) and/or THR (n = 3120; 54% female). Residential addresses were matched with the Australian Bureau of Statistics (ABS) 2011 census data: region of residence was defined according to local government areas (LGAs), and area-level SEP (quintiles) defined using an ABS-derived composite index. The ABS-determined control population (n = 591,265; 51% female) excluded individuals identified as cases. We performed multilevel logistic regression modelling using a stratified two-stage cluster design.
Results
TKR was higher for those aged 70–79 years (AOR 1.4 95%CI 1.3–1.5; referent = 60–69 years) and in the most advantaged SEP quintile (AOR 2.1, 95%CI 1.8–2.3; referent = SEP quintile 3); results were similar for THR (70–79 years = AOR 1.7, 95%CI 1.5–1.8; SEP quintile 5 = AOR 2.5, 95%CI 2.2–2.8). Total variances contributed by the variance in LGAs were 2% (SD random effects ± 0.28) and 3% (SD ± 0.32), respectively.
Conclusion
Independent of small between-LGA differences in utilisation, and in contrast to the expected greater prevalence of osteoarthritis in disadvantaged populations, we report greater TKR and THR in more advantaged groups. Further research should investigate whether more advantaged populations may be over-serviced.
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Change history
09 July 2018
The names of the co-authors Steven Graves and Michelle Lorimer were missing from the manuscript supplied for publication. The lead authors regret this error and apologize for any inconvenience.
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Acknowledgements
We would like to thank the AOA NJRR team, particularly Michelle Lorimer, for providing access to these data. The data from the AOA NJRR were used with permission. The dataset supporting the conclusions of this article are governed by the AOA NJRR (https://aoanjrr.sahmri.com/).
Funding
This study is funded by the Western Alliance Academic Health Science Centre, a partnership for research collaboration between Deakin University, Federation University and 13 health service providers operating across western Victoria. SLB-O and LJW are each supported by a NHMRC Career Development Fellowship (1107510 and 1064272, respectively). KLH is supported by an Alfred Deakin Postdoctoral Research Fellowship, Deakin University. MAS is supported by a Deakin University stipend via the IMPACT Strategic Research Centre.
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Contributions
SLB-O conceived the study and drafted the manuscript. SV undertook the analyses. All authors were involved in the study design and contributed to the interpretation of the background data; all authors provided critical appraisal of the manuscript for important intellectual content; and all authors approved the final manuscript.
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Significance for public health
The social and geographic patterning of primary TKR and THR surgery, and any relationships with age and sex, has not been described for this region. This study links data from Ageing, Chronic Disease and Injury (ACDI) study to the Australian Orthopaedic Association National Joint Replacement Registry, which is the most complete and extensive set of joint replacement data in Australia. This information is particularly important because the need for elective surgery, such as joint replacement for advanced osteoarthritis, may not correlate with the uptake of surgery for residents in these areas. Furthermore, osteoarthritis is more prevalent in rural and farming communities compared to the general population, due to risk factors specific to agricultural and farming activities, including biomechanical stress related to repetitive forceful activities.
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Brennan-Olsen, S., Vogrin, S., Holloway, K.L. et al. Geographic region, socioeconomic position and the utilisation of primary total joint replacement for hip or knee osteoarthritis across western Victoria: a cross-sectional multilevel study of the Australian Orthopaedic Association National Joint Replacement Registry. Arch Osteoporos 12, 97 (2017). https://doi.org/10.1007/s11657-017-0396-2
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DOI: https://doi.org/10.1007/s11657-017-0396-2