More Medicare recipients in rural than urban areas underwent joint replacements

Total joint replacement surgery was 27% more likely to be performed in Medicare beneficiaries residing in rural rather than urban areas. It was also performed more often in women than men who were Medicare recipients, based on a study in Arthritis & Rheumatism.

Researchers at Southern Illinois University studied the utilization of joint reconstruction procedures among 6 million rural and nearly 38 million urban Medicare recipients in 2005. They were surprised to find that more rural than urban participants in the Medicare program underwent elective joint arthroplasty, based on information in a press release.

"There was reason to believe that differences in physician access, cultural backgrounds, and the need to travel further for surgery would deter more rural patients from elective surgical procedures," lead researcher Mark L. Francis, MD, explained in an Arthritis & Rheumatism press release.

Racial disparities

In their study, Francis and colleagues reported some disparities related to total joint replacement (TJR) between white individuals and minorities living in rural and urban settings, but found they were less pronounced among those in rural areas.

Racial representation among the Medicare beneficiaries studied in the rural areas was 90.8% white, 6.4% African American, 0.6% Hispanic, 0.2% Asian, 1.3% Native American and 0.5% other races. By comparison, urban beneficiaries were 83.2% white, 10.5% African American, 2.3% Hispanic, 1.9% Asian, 0.3% Native American and 1.7% other.

Researchers used the 2005 Medicare Provider Analysis and Review File from the Centers for Medicare & Medicaid Services and the 2005 Medicare Denominator File to identify the study groups.

The mean age in both groups was about the same — 70 or 71 years old, according to the release.

Expected gender differences

In 2005, 1.02% of rural Medicare participants underwent total knee or hip replacement surgery vs. 0.08% of urban participants, according to the study's results.

The overall findings concurred with those from prior studies concerning the greater likelihood for women to have TJR surgery than men.

"While our study explored differences between rural and urban areas, joint replacement surgeries in suburban populations is an important area for future research," Francis stated in the release, noting the findings should not be generalized to populations in less-industrialized countries.

Reference:
Francis ML, Scaife SL, Zahnd WE, et al. Joint replacement surgeries among Medicare beneficiaries in rural compared with urban areas. Arthritis Rheum. 2009;60: 3554-3562.