Peoples’ access across England to total joint replacement of the hip or knee is uneven and affected unfairly by age, sex, deprivation, geography and ethnicity, according to a new study published in the British Medical Journal.
The results show that women, elderly people, and those in deprived areas continue to be worse off.
Total joint replacement of the hip or knee is a common procedure, which is cost effective and boosts public health. There were 82,419 knee operations in 2008-09 in England and 77,608 hip operations.
Researchers from the UK and Canada set out to explore the geographical and socio-demographic factors linked to variation in equity of access to these operations.
They used data from the Somerset and Avon Survey of Health (a small-area population based survey), the English Hospital Episode Statistics (HES) database and the English Longitudinal Study of Aging (ELSA) – a nationally representative population based survey of 11,329 people aged 50 and over living in private households in England.
Results showed that people aged 60-84 were more than twice as likely to have received an operation than people aged 50-59, despite all people in both groups having an equal need. People aged 85 and over, however, were less likely to have had the operations.
Men received 31% more knee replacements relative to need than women and 8% more for hip replacements.
People living in deprived areas were found to receive around 70% less provision relative to need compared with the most affluent areas for both knee and hip replacements.
Those living in urban areas got greater provision of knee replacement relative to need than people living in more isolated places, but the effect was different for hip replacement with people in villages or isolated areas getting the most provision relative to need.
The ethnic mix of an area made no difference for hip replacements, but people living in non-white areas were more likely to receive a knee replacement than people residing in mostly white areas.
The authors conclude: "Policy makers should examine factors at the patient or primary care level to understand the determinants of inequitable provision."
(Souce: Press Release)