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
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.
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.
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.
KeywordsEpidemiology Geographic region Joint replacements Registry data Social disadvantage
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/).
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.
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.
- 2.AIHW (2008) Rural and remote health: indicators of health status and determinants of health. Rural Health Series Number 9. Australian Institute of Health and Welfare, CanberraGoogle Scholar
- 3.Romanow RJQ (2002) Building on values: the future of health care in Canada, Final Report. National Library of Canada; Commission on the Future of Health Care in Canada, CanadaGoogle Scholar
- 6.NRHA (2014) Income inequality experienced by the people of rural and remote Australia: submission to the senate inquiry into the extent of income inequality in Australia. National Rural Health Alliance, CanberraGoogle Scholar
- 7.Kirkhorn S, Greenlee RT, Reeser JC (2003) The epidemiology of agriculture-related osteoarthritis and its impact on occupational disability. Wisconsin Med J 102:38–44Google Scholar
- 9.Sajjad MA, Holloway KL, Kotowicz MA, Livingston PM, Khasraw M, Hakkennes S, Dunning TL, Brumby S, Page RS, Pedler D, Sutherland A, Venkatesh S, Brennan-Olsen SL, Williams LJ, Pasco JA (2016) Ageing, chronic disease and injury: a study in western Victoria (Australia). J Public Health Res 5:81–86CrossRefGoogle Scholar
- 10.AOANJRR (2009) Demographics of hip and knee arthroplasty. AOANJRR, Adelaide, pp 1–33Google Scholar
- 11.Brennan SL, Stanford T, Wluka AE, Page RS, Graves SE, Kotowicz MA, Nicholson GC, Pasco JA (2012) Utilisation of primary total knee joint replacements across socioeconomic status in the Barwon Statistical Division, Australia, 2006-2007: a cross-sectional study. BMJ Open 2:e001310CrossRefPubMedPubMedCentralGoogle Scholar
- 12.ABS (2011) Australian statistical geography standard (ASGS): volume 3—non ABS structures July 2011. Cat: 1270.0.55.003. ABS, Canberra, AustGoogle Scholar
- 13.StataCorp (2013) Stata statistical software: release. StataCorp LP, College Station, Texas, p 13Google Scholar
- 14.AIHW (2007) A picture of osteoarthritis in Australia 2007. Australian Institute of Health and Welfare, CanberraGoogle Scholar
- 15.Brennan SL, Lane SE, Lorimer M, Buchbinder R, Wluka AE, Page RS, Osborne RH, Pasco JA, Sanders KM, Cashman K, Ebeling PR, Graves SE (2014) Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003-10: data from the Australian Orthopaedic Association National Joint Replacement Registry. BMC Musculoskelet Dis 15:356CrossRefGoogle Scholar
- 17.Johnson A (2014) Health literacy, does it make a difference? Aust J Adv Nursing 31:39–45Google Scholar
- 19.Clement ND (2013) Patient factors that influence the outcome of total knee replacement: a critical review of the literature. OA Orthop 1:11Google Scholar
- 23.Brennan-Olsen SL, Page RS, Lane SE, Lorimer M, Buchbinder R, Osborne RH, Pasco JA, Wluka AE, Sanders KM, Ebeling PR, Graves SE (2016) Few geographic and socioeconomic variations in primary total shoulder arthroplasty: a multi-level study of Australian registry data. BMC Musculoskelet Dis 17:291CrossRefGoogle Scholar