Analysis of regional variation in hip and knee joint replacement rates in England using Hospital Episodes Statistics.
ABSTRACT Total hip and knee joint replacements are effective interventions for people with severe arthritis, and demand for these operations appears to be increasing as our population ages. This study explores regional variations in health care and inequalities in the provision of these expensive interventions, which are high on the UK Government's health agenda.
The Hospital Episode Statistics (HES) for England were analysed. The HES database holds information on patients who are admitted to National Health Service (NHS) hospitals in England.
Age-standardized procedure rates were calculated using 5-year age groups with the English mid-year population of 2000 as the reference. Univariate associations between age-standardized operation rates and regional characteristics were assessed using Pearson's correlation coefficient.
Age and sex-standardized surgery rates vary by 25-30%. For both hip and knee replacement, rates are highest in the South West and Midlands and lowest in the North West, South East and London regions. In the case of knee replacement, there are also marked differences in the sex ratios between regions. The variable that explained most variation in hip replacement rates was the proportion of older people in the region. In the case of knee replacement, the number of NHS centres offering surgery in the region was the main explanatory variable, with regions with fewer centres having the highest provision rates.
These data can help to inform planning of services. They suggest that there may be inequities as well as inequalities in the provision of primary joint replacement surgery in England.
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ABSTRACT: Surgical treatment for degenerative conditions of the hip, knee, and spine has an impact on overall healthcare spending. Surgical rates have increased dramatically and considerable regional variation has been observed. The reasons behind these increasing rates and variation across regions have not been well elucidated. We therefore identified demographic (D), social structure (SS), health belief (HB), personal (PR) and community resources (CR), and medical need (MN) factors that drive rates of hip, knee, and spine surgery. We conducted a systematic review to include all observational, population-based studies that compared surgical rates with potential drivers (D, SS, HB, PR, CR, MN). We searched PubMed combining key words focusing on (1) disease and procedure; (2) study methodology; and (3) explanatory models. Independent investigators selected potentially eligible studies from abstract review and abstracted methodological and outcome data. From an initial search of 256 articles, we found 37 to be potentially eligible (kappa 0.86) but only 28 met all our inclusion criteria. Age, nonminority, insurance coverage, and surgeon enthusiasm all increased surgical rates. Rates of arthroplasty were higher for females with higher education, income, obesity, rurality, willingness to consider surgery, and prevalence of disease, whereas spinal rates increased with male gender, lower income, and the availability of advanced imaging. Regional variation in these procedures exists because they are examples of preference-sensitive care. With strategies that may affect change in factors that are potentially modifiable by behavior or resources, extreme variation in rates may be reduced.Clinical Orthopaedics and Related Research 08/2011; 470(4):1090-105. · 2.79 Impact Factor
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ABSTRACT: Objectives: To estimate the lifetime risk of total knee replacement (TKR) and examine temporal trends in TKR incidence in the state of Victoria, Australia. Methods: A retrospective analysis of a population-based longitudinal cohort of patients (aged ≥40) who received a primary TKR in Victoria from 1999 to 2008. Hospital separations and life tables were used to estimate lifetime risk. Temporal changes in TKR incidence were examined according to healthcare setting (public versus private), socio-economic status (SES) and geographic location (regional versus metropolitan). Results: There were 43,570 incidents of primary TKRs identified over the study period. In 2008, the lifetime risk of surgery was 10.4% (95% CI: 10.13%-10.64%) for males and 11.9% (95% CI: 11.63%-12.13%) for females. TKRs increased steadily over the study period in private hospitals (overall increase of 90%) with a smaller growth in procedure numbers for public hospitals (overall increase of 40%). From 2002-2003 onwards, the low SES tertile showed a lower incidence of TKR compared to the middle and high SES group with incidence rates of 1.09 (95% CI: 1.04-1.15), 1.22 (95% CI: 1.17-1.28) and 1.20 (95% CI: 1.16-1.25) per 1000 population respectively (based on 2007-08 figures). Increased numbers of TKRs were also found to be occurring among people residing in regional areas of Victoria (from 1.12 (95% CI: 1.04-1.31) to 1.84 (95% CI: 1.72-2.02) per 1000 population. Conclusion: Increases in lifetime risk of TKR were evident. Although improved access to TKR for those living in regional areas was observed, sustained disparities relating to healthcare setting and SES warrant further investigation. © 2013 American College of Rheumatology.Arthritis care & research. 08/2013;