The opinions expressed by the authors are theirs alone and do not represent the opinions of supporting organizations. The developers and funders of the English Longitudinal Study of Ageing and the UK Data Archive do not bear any responsibility for the analyses or interpretations presented here.
Health Care Planning
Modeling the need for hip and knee replacement surgery. Part 2. Incorporating census data to provide small-area predictions for need with uncertainty bounds†
Article first published online: 30 NOV 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis Care & Research
Volume 61, Issue 12, pages 1667–1673, 15 December 2009
How to Cite
Judge, A., Welton, N. J., Sandhu, J. and Ben-Shlomo, Y. (2009), Modeling the need for hip and knee replacement surgery. Part 2. Incorporating census data to provide small-area predictions for need with uncertainty bounds. Arthritis & Rheumatism, 61: 1667–1673. doi: 10.1002/art.24732
- Issue published online: 30 NOV 2009
- Article first published online: 30 NOV 2009
- Manuscript Accepted: 26 MAY 2009
- Manuscript Received: 27 JAN 2009
- Medical Research Council/Health Services Research Collaboration at the Department of Social Medicine, University of Bristol
- UK Medical Research Council
- National Coordinating Centre for Research Capacity Development Department of Health Public Health Initiative 2003
- The data are from the English Longitudinal Study of Ageing, which receives funding from the US National Institute on Aging
- Consortium of UK government departments coordinated by the Office for National Statistics
To develop methods to produce small-area estimates of need for hip and knee replacement surgery to inform local health service planning.
Multilevel Poisson regression modeling was used to estimate rates of need for hip/knee replacement by age, sex, deprivation, rurality, and ethnic mix using a nationally representative population-based survey (the English Longitudinal Study of Ageing, n = 11,392 people age ≥50 years). Estimates of need from the regression model were then combined with stratified census population counts to produce small-area predictions of need. Uncertainty in the predictions was obtained by taking a Bayesian simulation-based approach using WinBUGS software. This allows correlations in parameter estimates to be appropriately incorporated in the credible intervals for the small-area predictions.
Small-area estimates of need for hip/knee replacement have been produced for wards and districts in England. Rates of need are adjusted for the sociodemographic characteristics of an area and include 95% credible intervals. Need for hip/knee replacement varies geographically, dependant on the sociodemographic characteristics of an area.
For the first time, small-area estimates of need for hip/knee replacement surgery have been produced together with estimates of uncertainty to inform local health planning. The methodologic approach described here could be reproduced in other countries and for other disease indicators. Further research is required to combine small-area estimates of need with provision to determine whether there is equitable access to care.