Inequities exist in access to total hip and knee replacement across England

Researchers reported inequalities — based on age, sex, income, area of residence and ethnicity — in access to total knee and hip replacement throughout England.

The study, conducted by Andy Judge, senior statistician at the University of Bristol, and colleagues, was published in the British Medical Journal (BMJ).

“Hospital provider characteristics did not explain the observed inequities by age, sex, deprivation, rurality, and ethnic group, suggesting causes of inequity might lie further down the care pathway at the level of the patient, general practitioner, or consultant,” Judge and colleagues wrote.

Predicting the rate of need

The researchers sought to assess the geographical and sociodemographic factors associated with variation in equity in access to total hip replacement (THR) and total knee replacement (TKR). They analyzed data from the Somerset and Avon Survey of Health (a small-area population-based study), the English Hospital Episode Statistics database and the English Longitudinal Study of Aging. The information obtained was used to predict rates of need for THR and TKR and to calculate the actual provision of these operations, according to a BMJ press release.

Judge and colleagues reported a higher “provision relative to need” for THR and TKR among the following groups: people aged 50 to 59 years, compared to those aged 60 to 84 years; men compared to women; people in the least deprived areas, compared to those in the most deprived areas.

People from urban areas received higher provision of TKR relative to need, while people from villages and isolated areas received higher provision of THR relative to need. Additionally, people living in non-white areas received higher provision of TKR relative to need compared with those in predominantly white areas, according to the study results.

Novel methodology

“In this study, we have developed a novel methodological approach combining small area estimates on the need for surgical provision of hip and knee replacement surgery to explore evidence of inequity in access to care,” the authors wrote. “The method described here is general and can be applied to other important equity indicators.”

In an accompanying commentary, Profs. Ann Bowling and Martin McKee claimed that while this study provides a major methodological advance, the data are from 2002; since then, the under-provisions may have been alleviated by increased investments in the U.K. National Health Service (NHS).

Further analyses using NHS and private-sector data are needed to determine if the population’s health needs are being met, according to Bowling and McKee.

Judge and colleagues agreed that future studies are warranted, as their study does not offer a solution to the inequities they have observed. “Future research is required to enable the design of interventions that could ameliorate these patterns,” they concluded.

Reference:
Judge A. BMJ. 2010;341:c4092. doi:10.1136/bmj.c4092.

Follow OrthoSuperSite.com on Twitter