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Archives of Osteoporosis

, 12:97 | Cite as

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

  • Sharon Brennan-Olsen
  • Sara Vogrin
  • Kara L. Holloway
  • Richard S. Page
  • Muhammad A. Sajjad
  • Mark A. Kotowicz
  • Patricia M. Livingston
  • Mustafa Khasraw
  • Sharon Hakkennes
  • Trish L. Dunning
  • Susan Brumby
  • Daryl Pedler
  • Alasdair Sutherland
  • Svetha Venkatesh
  • Lana J. Williams
  • Gustavo Duque
  • Julie A. Pasco
Original Article

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.

Keywords

Epidemiology Geographic region Joint replacements Registry data Social disadvantage 

Notes

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/).

Author 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.

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.

Supplementary material

11657_2017_396_MOESM1_ESM.docx (13 kb)
ESM 1 (DOCX 13 kb)

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • Sharon Brennan-Olsen
    • 1
    • 2
    • 3
    • 4
  • Sara Vogrin
    • 1
  • Kara L. Holloway
    • 3
  • Richard S. Page
    • 3
    • 5
  • Muhammad A. Sajjad
    • 3
  • Mark A. Kotowicz
    • 2
    • 3
    • 6
  • Patricia M. Livingston
    • 3
  • Mustafa Khasraw
    • 3
    • 7
  • Sharon Hakkennes
    • 6
  • Trish L. Dunning
    • 3
  • Susan Brumby
    • 3
    • 8
  • Daryl Pedler
    • 3
  • Alasdair Sutherland
    • 3
    • 9
  • Svetha Venkatesh
    • 3
  • Lana J. Williams
    • 3
  • Gustavo Duque
    • 1
    • 2
  • Julie A. Pasco
    • 2
    • 3
    • 10
  1. 1.Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthSt AlbansAustralia
  2. 2.Department of MedicineThe University of Melbourne-Western HealthSt AlbansAustralia
  3. 3.Deakin UniversityGeelongAustralia
  4. 4.Institute for Health and AgeingAustralian Catholic UniversityMelbourneAustralia
  5. 5.Barwon Centre for Orthopaedic Research and Education (B-CORE)Barwon Health and St John of God HospitalGeelongAustralia
  6. 6.University Hospital Geelong, Barwon HealthGeelongAustralia
  7. 7.University of SydneySydneyAustralia
  8. 8.National Centre for Farmer Health, Western District Health ServiceHamiltonAustralia
  9. 9.South West HealthcareWarrnamboolAustralia
  10. 10.Department of Preventive Medicine and EpidemiologyMonash UniversityPrahranAustralia

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