Get access

Variation in rates of hip and knee joint replacement in Australia based on socio-economic status, geographical locality, birthplace and indigenous status

Authors

  • Tracy Dixon,

    1. National Centre for Monitoring Arthritis and Musculoskeletal Conditions, Australian Institute of Health and Welfare, Canberra, Australian Capital Territory
    Search for more papers by this author
    • Joint first authors.

  • Donna M. Urquhart,

    Corresponding author
    1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
      Dr Donna Urquhart, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Vic. 3004, Australia. Email: donna.urquhart@med.monash.edu.au
    Search for more papers by this author
    • Joint first authors.

  • Patricia Berry,

    1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
    Search for more papers by this author
  • Kuldeep Bhatia,

    1. National Centre for Monitoring Arthritis and Musculoskeletal Conditions, Australian Institute of Health and Welfare, Canberra, Australian Capital Territory
    Search for more papers by this author
  • Yuanyuan Wang,

    1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
    Search for more papers by this author
  • Stephen Graves,

    1. Department of Medicine, Melbourne University, Melbourne, Victoria, Australia
    Search for more papers by this author
  • Flavia M. Cicuttini

    1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
    Search for more papers by this author

  • Sources of support: DU was supported by a Monash Senior Research Fellowship.

  • T. Dixon BMath/BSc(Hons), MAppStats; D. M. Urquhart BPhysio(Hons), PhD; P. Berry BBioMedSci(Hons); K. Bhatia MSc, PhD; Y. Wang MMed, MD, PhD; S. Graves MBBS, DPhil; F. M. Cicuttini MSc, MBBS, FRACP, PhD.

Dr Donna Urquhart, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Vic. 3004, Australia. Email: donna.urquhart@med.monash.edu.au

Abstract

Background:  Our understanding of the incidence of joint replacement across different subgroups of the Australian population is limited. This study investigated whether rates of hip and knee joint replacement vary according to socio-economic status, geographical locality, birthplace and indigenous status.

Methods:  Data from the National Hospital Morbidity Database were obtained. All separations for primary hip or knee joint replacement with the principal diagnosis of arthritis were identified. Age-standardized procedure rates were compared based on socio-economic status, geographical locality, birthplace and indigenous status.

Results:  Compared with age- and gender-matched individuals, rates of joint replacement overall were significantly lower in people living in the most disadvantaged (P < 0.05) and remote areas (P < 0.001), people born outside Australia (P < 0.05) and indigenous people (P < 0.001). However, there were some exceptions. Knee replacement rates were higher in the most disadvantaged areas than in the least disadvantaged areas (P < 0.01), and both hip and knee replacement rates were higher in regional areas than in major cities (P < 0.05). Males and females born in New Zealand and females born in the United Kingdom, Ireland and parts of Europe had a greater rate of hip replacement, and females from North Africa and the Middle East had a greater rate of knee replacement, than Australia-born people (P < 0.001).

Conclusions:  There is significant variation in the rates of primary total hip and knee replacement in Australia. Further investigation is needed to determine whether this simply reflects patterns of disease and disease risk factors, or is because of inequalities in health care, unmet need, and/or surgical or patient-related factors.

Get access to the full text of this article

Ancillary