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Ekhtiari S, Pincus D, Croxford R, Gatley JM, Khoshbin A, Atrey A, Paterson JM, Ravi B. Impact of the coronavirus disease 2019 pandemic on equity of access to hip and knee replacements: a population-level study. INTERNATIONAL ORTHOPAEDICS 2024; 48:635-642. [PMID: 38012311 DOI: 10.1007/s00264-023-06042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The COVID-19 pandemic had innumerable impacts on healthcare delivery. In Canada, this included limitations on inpatient capacity, which resulted in an increased focus on outpatient surgery for non-emergent cases such as joint replacements. The objective of this study was to assess whether the pandemic and the shift towards outpatient surgery had an impact on access to joint replacement for marginalized patients. METHODS Data from Ontario's administrative healthcare databases were obtained for all patients undergoing an elective hip or knee replacement between January 1, 2018 and August 31, 2021. All surgeries performed before March 15, 2020 were classified as "pre-COVID," while all procedures performed after that date were classified as "post-COVID." The Ontario Marginalization Index domains were used to analyze proportion of marginalized patients undergoing surgery pre- and post-COVID. RESULTS A total of 102,743 patients were included-42,812 hip replacements and 59,931 knee replacements. There was a significant shift towards outpatient surgery during the post-COVID period (1.1% of all cases pre-COVID to 13.2% post-COVID, p < 0.001). In the post-COVID cohort, there were significantly fewer patients from some marginalized groups, as well as fewer patients with certain co-morbidities, such as congestive heart failure and chronic obstructive pulmonary disease. CONCLUSION The most important finding of this population-level database study is that, compared to before the COVID-19 pandemic, there has been a change in the profile of patients undergoing hip and knee replacements in Ontario, specifically across a range of indicators. Fewer marginalized patients are undergoing joint replacement surgery since the COVID-19 pandemic. Further monitoring of access to joint replacement surgery is required in order to ensure that surgery is provided to those who are most in need.
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Affiliation(s)
- Seper Ekhtiari
- Addenbrooke's - Cambridge University Hospitals, University of Cambridge, Cambridge, UK.
- Division of Orthopaedic Surgery, Sinai Health, University of Toronto, 476B-600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Daniel Pincus
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Amir Khoshbin
- ICES, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- ICES, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Bheeshma Ravi
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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2
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Munugoda IP, Brennan-Olsen SL, Wills K, Cai G, Graves SE, Lorimer M, Cicuttini FM, Callisaya ML, Aitken D, Jones G. The association between socioeconomic status and joint replacement of the hip and knee: A population-based cohort study of older adults in Tasmania. Intern Med J 2020; 52:265-271. [PMID: 32975868 DOI: 10.1111/imj.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A socioeconomic gradient exists in the utilisation of total hip replacements (THR) and total knee replacements (TKR) for osteoarthritis. However, the relations between socioeconomic status (SES) and time to THR or TKR is unknown. AIM To describe the association between SES and time to THR and TKR. METHODS 1072 older-adults residing in Tasmania, Australia were studied. Incident primary THR and TKR were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. At baseline, each participant's area-level SES was determined by the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD), from the Australian Bureau of Statistics' 2001 census data. IRSAD was analysed in two ways; 1) categorised into quartiles, whereby quartile 1 represented the most socioeconomically disadvantaged group, 2) the cohort dichotomised at the quartile 1 cut-point. RESULTS The mean age was 63.0 (±7.5) years, and 51% were women. Over the median follow-up of 12.9 (Interquartile range: 12.2-13.9) years, 56 (5%) participants had a THR, and 79 (7%) had a TKR. Compared to the most disadvantaged quartile, less disadvantaged participants were less likely to have a THR (i.e. less disadvantaged participants had a longer time to THR) (HR: 0.56, 95% CI 0.32, 1.00) but not TKR (HR: 0.90, 95% CI 0.53, 1.54). However, the former became non-significant after adjustment for pain and radiographic osteoarthritis, suggesting that the associations may be mediated by these factors. CONCLUSIONS This study suggests that time to joint replacement was determined according to the symptoms/need of the participants rather than their SES. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ishanka P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Guoqi Cai
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Lao C, Lees D, Patel S, White D, Lawrenson R. Geographical and ethnic differences of osteoarthritis-associated hip and knee replacement surgeries in New Zealand: a population-based cross-sectional study. BMJ Open 2019; 9:e032993. [PMID: 31542769 PMCID: PMC6756428 DOI: 10.1136/bmjopen-2019-032993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To (1) explore the regional and ethnic differences in rates of publicly funded osteoarthritis-associated hip and knee replacement surgeries and (2) investigate the mortality after surgery. DESIGN Population-based, retrospective, cross-sectional study. SETTING General population in New Zealand. PARTICIPANTS Patients with osteoarthritis who underwent publicly funded primary hip and knee replacement surgeries in 2005-2017. Patients aged 14-99 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES Age-standardised rate, standardised mortality ratio (SMR) and 30 days, 90 days and 1 year mortality. RESULTS We identified 53 439 primary hip replacements and 50 072 primary knee replacements with a diagnosis of osteoarthritis. The number and age-standardised rates of hip and knee replacements increased over time. Māori had the highest age-standardised rate of hip replacements, followed by European/others and Pacific, and Asian had the lowest rate. Pacific had the highest age-standardised rate of knee replacements, followed by Māori and European/others, and Asian had the lowest rate. The Northern Health Network had the lowest rate of hip surgeries, and the Southern Health Network had the lowest rate of knee surgeries. The SMRs of patients undergoing hip and knee replacements were lower than the general population: 0.92 (95% CI 0.89 to 0.95) for hip and 0.79 (95% CI 0.76 to 0.82) for knee. The SMRs were decreasing over time. The patterns of 30 days, 90 days and 1 year mortality were similar to the SMR. CONCLUSIONS The numbers of publicly funded osteoarthritis-associated primary hip and knee replacements are steadily increasing. Māori people had the highest age-standardised rate of hip replacements and Pacific people had the highest rate of knee replacements. The Northern Health Network had the lowest rate of hip surgeries, and the Southern Health Network had the lowest rate of knee surgeries. Compared with the general population, patients who had hip and knee replacements have a better life expectancy.
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Affiliation(s)
- Chunhuan Lao
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - David Lees
- Orthopaedic Department, Tauranga Hospital, Tauranga, New Zealand
| | - Sandeep Patel
- Orthopaedic Department, Waikato Hospital, Hamilton, New Zealand
| | - Douglas White
- Rheumatology Department, Waikato District Health Board, Hamilton, New Zealand
- Waikato Clinical School, The University of Auckland, Auckland, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand
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Brennan-Olsen SL, Vogrin S, Graves S, Holloway-Kew KL, Page RS, Sajjad MA, Kotowicz MA, Livingston PM, Khasraw M, Hakkennes S, Dunning TL, Brumby S, Sutherland AG, Talevski J, Green D, Kelly TL, Williams LJ, Pasco JA. Revision joint replacement surgeries of the hip and knee across geographic region and socioeconomic status in the western region of Victoria: a cross-sectional multilevel analysis of registry data. BMC Musculoskelet Disord 2019; 20:300. [PMID: 31238918 PMCID: PMC6591811 DOI: 10.1186/s12891-019-2676-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residents of rural and regional areas, compared to those in urban regions, are more likely to experience geographical difficulties in accessing healthcare, particularly specialist services. We investigated associations between region of residence, socioeconomic status (SES) and utilisation of all-cause revision hip replacement or revision knee replacement surgeries. METHODS Conducted in western Victoria, Australia, as part of the Ageing, Chronic Disease and Injury study, data from the Australian Orthopaedic Association National Joint Replacement Registry (2011-2013) for adults who underwent a revision hip replacement (n = 542; 54% female) or revision knee replacement (n = 353; 54% female) were extracted. We cross-matched residential addresses with 2011 census data from the Australian Bureau of Statistics (ABS), and using an ABS-derived composite index, classified region of residence according to local government areas (LGAs), and area-level SES into quintiles. For analyses, the control population (n = 591,265; 51% female) was ABS-determined and excluded adults already identified as cases. Mixed-effects logistic regression was performed. RESULTS We observed that 77% of revision hip surgeries and 83% of revision knee surgeries were performed for residents in the three most socially disadvantaged quintiles. In adjusted multilevel models, total variances contributed by the variance in LGAs for revisions of the hip or knee joint were only 1% (SD random effects ±0.01) and 3% (SD ± 0.02), respectively. No differences across SES or sex were observed. CONCLUSIONS No differences in utilisation were identified between SES groups in the provision of revision surgeries of the hip or knee, independent of small between-LGA differences.
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Affiliation(s)
- Sharon L Brennan-Olsen
- Department of Medicine, The University of Melbourne-Western Health, Level 3, WHCRE Building, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne-Western Health, Level 3, WHCRE Building, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Level 4, North Terrace, Adelaide, SA, 5000, Australia
| | | | - Richard S Page
- Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital, Myers Street, Geelong, VIC, 3220, Australia
| | - M Amber Sajjad
- Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.,Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia.,Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital, Myers Street, Geelong, VIC, 3220, Australia
| | | | - Mustafa Khasraw
- Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia.,University of Sydney, Parramatta Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Sharon Hakkennes
- Barwon Health, University Hospital Geelong, Ryrie Street, Geelong, VIC, 3220, Australia
| | | | - Susan Brumby
- Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia.,National Centre for Farmer Health, Western District Health Service, Tyers Street, Hamilton, VIC, 3300, Australia
| | - Alasdair G Sutherland
- Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia.,South West Healthcare, 25 Ryot Street, Warrnambool, VIC, 3280, Australia
| | - Jason Talevski
- Department of Medicine, The University of Melbourne-Western Health, Level 3, WHCRE Building, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia
| | - Darci Green
- Department of Medicine, The University of Melbourne-Western Health, Level 3, WHCRE Building, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia
| | - Thu-Lan Kelly
- School of Pharmacy and Medical Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, SA, 5001, Australia
| | - Lana J Williams
- Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia
| | - Julie A Pasco
- Department of Medicine, The University of Melbourne-Western Health, Level 3, WHCRE Building, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, VIC, 3021, Australia.,Deakin University, Pigdon Road, Geelong, VIC, 3220, Australia.,Department of Preventive Medicine and Epidemiology, Monash University, Alfred Centre, 99 Commercial Road, Prahran, VIC, 3004, Australia
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Ackerman IN, Page RS, Fotis K, Schoch P, Broughton N, Brennan-Olsen SL, Bucknill A, Cross E. Exploring the personal burden of shoulder pain among younger people in Australia: protocol for a multicentre cohort study. BMJ Open 2018; 8:e021859. [PMID: 30030319 PMCID: PMC6059320 DOI: 10.1136/bmjopen-2018-021859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Persistent musculoskeletal conditions can impact profoundly on younger people's quality of life, psychological distress and capacity to work, as shown by previous research involving younger people with osteoarthritis. The personal impacts, in particular, work and parenting impacts, of other musculoskeletal conditions (such as persistent shoulder pain) on younger patient groups remain poorly understood. Furthermore, the personal financial burden associated with managing musculoskeletal conditions is rarely documented. This study aims to investigate well-being, work participation and productivity, shoulder-related parenting disability and out-of-pocket healthcare expenditure among younger people with shoulder pain and evaluate changes over 12 months. METHODS AND ANALYSIS One hundred and fifty people aged 20-55 years with shoulder pain of more than 6 weeks' duration (excluding those with recent history of fracture or dislocation) will be recruited for this cohort study. Participants will be recruited from three major public hospitals in Victoria, Australia, following screening of orthopaedic outpatient clinics lists and referrals. Participants will be asked to complete a baseline questionnaire and 2-week healthcare costs diary, with follow-up data collected at 12 months. Patient-reported outcomes will be collected, including health-related quality of life (HRQoL), shoulder pain and function, psychological distress, shoulder-related parenting disability and work productivity. Information on sociodemographics, employment, health services utilisation and shoulder-related healthcare expenditure will also be collected. Descriptive analysis of baseline data will provide a comprehensive snapshot of the personal burden of shoulder pain. Baseline HRQoL and psychological distress data will be compared with Australian population norms to provide context around well-being. Associations between sociodemographic factors and patient-reported outcomes will be evaluated using univariate and multivariate analyses. Changes in patient-reported outcomes from baseline to 12 months will be analysed using paired t-tests. ETHICS AND DISSEMINATION Ethics approval has been obtained. The study findings will be submitted to peer-reviewed journals and presented at relevant scientific meetings.
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Affiliation(s)
- Ilana N Ackerman
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Richard S Page
- Barwon Orthopaedic Research and Education, Barwon Health and School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kathy Fotis
- Department of Epidemiology and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Peter Schoch
- Physiotherapy Department, Barwon Health, Geelong, Victoria, Australia
| | - Nigel Broughton
- Orthopaedic Department, Frankston Hospital, Frankston, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science, Melbourne, Victoria, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emily Cross
- Physiotherapy Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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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. Arch Osteoporos 2017; 12:97. [PMID: 29110097 DOI: 10.1007/s11657-017-0396-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/25/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED 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.
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7
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Brennan-Olsen SL, Page RS, Lane SE, Lorimer M, Buchbinder R, Osborne RH, Pasco JA, Wluka AE, Sanders KM, Ebeling PR, Graves SE. Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data. BMC Musculoskelet Disord 2016; 17:291. [PMID: 27421770 PMCID: PMC4947280 DOI: 10.1186/s12891-016-1134-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 06/17/2016] [Indexed: 11/17/2022] Open
Abstract
Background Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007–11 for all Australians aged ≥40 years. Methods Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling. Results During 2007–11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales. Conclusions Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.
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Affiliation(s)
- Sharon L Brennan-Olsen
- School of Medicine, Deakin University, Geelong, Australia. .,Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia. .,Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia. .,Epi-Centre for Healthy Aging, IMPACT Strategic Research Centre, Deakin University, (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.
| | - Richard S Page
- School of Medicine, Deakin University, Geelong, Australia.,Barwon Orthopaedic Research Unit, Barwon Health, Geelong, Australia
| | - Stephen E Lane
- School of Medicine, Deakin University, Geelong, Australia.,Barwon Health Biostatistics Unit, Barwon Health, University Hospital, Geelong, Australia.,School of BioSciences, University of Melbourne, Melbourne, Australia
| | - Michelle Lorimer
- Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Melbourne, Australia.,Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Australia
| | - Richard H Osborne
- School of Health and Social Development, Deakin University, Melbourne, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Melbourne, Australia
| | - Kerrie M Sanders
- Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia.,Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Peter R Ebeling
- Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia.,NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia
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