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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

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A Correction to this article was published on 09 July 2018

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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.

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Change history

  • 09 July 2018

    The names of the co-authors Steven Graves and Michelle Lorimer were missing from the manuscript supplied for publication. The lead authors regret this error and apologize for any inconvenience.

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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/).

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.

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Authors and Affiliations

  1. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Level 3, WHCRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia

    Sharon Brennan-Olsen, Sara Vogrin & Gustavo Duque

  2. Department of Medicine, The University of Melbourne-Western Health, St Albans, VIC, Australia

    Sharon Brennan-Olsen, Mark A. Kotowicz, Gustavo Duque & Julie A. Pasco

  3. Deakin University, Geelong, VIC, Australia

    Sharon Brennan-Olsen, Kara L. Holloway, Richard S. Page, Muhammad A. Sajjad, Mark A. Kotowicz, Patricia M. Livingston, Mustafa Khasraw, Trish L. Dunning, Susan Brumby, Daryl Pedler, Alasdair Sutherland, Svetha Venkatesh, Lana J. Williams & Julie A. Pasco

  4. Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia

    Sharon Brennan-Olsen

  5. Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health and St John of God Hospital, Geelong, VIC, Australia

    Richard S. Page

  6. University Hospital Geelong, Barwon Health, Geelong, VIC, Australia

    Mark A. Kotowicz & Sharon Hakkennes

  7. University of Sydney, Sydney, NSW, Australia

    Mustafa Khasraw

  8. National Centre for Farmer Health, Western District Health Service, Hamilton, VIC, Australia

    Susan Brumby

  9. South West Healthcare, Warrnambool, VIC, Australia

    Alasdair Sutherland

  10. Department of Preventive Medicine and Epidemiology, Monash University, Alfred Centre, Prahran, VIC, Australia

    Julie A. Pasco

Authors
  1. Sharon Brennan-Olsen
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  2. Sara Vogrin
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  3. Kara L. Holloway
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  4. Richard S. Page
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  5. Muhammad A. Sajjad
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  6. Mark A. Kotowicz
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  7. Patricia M. Livingston
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  8. Mustafa Khasraw
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  9. Sharon Hakkennes
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  10. Trish L. Dunning
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  11. Susan Brumby
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  12. Daryl Pedler
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  13. Alasdair Sutherland
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  14. Svetha Venkatesh
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  15. Lana J. Williams
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  16. Gustavo Duque
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  17. Julie A. Pasco
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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.

Corresponding author

Correspondence to Sharon Brennan-Olsen.

Additional information

Significance for public health

The social and geographic patterning of primary TKR and THR surgery, and any relationships with age and sex, has not been described for this region. This study links data from Ageing, Chronic Disease and Injury (ACDI) study to the Australian Orthopaedic Association National Joint Replacement Registry, which is the most complete and extensive set of joint replacement data in Australia. This information is particularly important because the need for elective surgery, such as joint replacement for advanced osteoarthritis, may not correlate with the uptake of surgery for residents in these areas. Furthermore, osteoarthritis is more prevalent in rural and farming communities compared to the general population, due to risk factors specific to agricultural and farming activities, including biomechanical stress related to repetitive forceful activities.

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Brennan-Olsen, S., Vogrin, S., Holloway, K.L. et al. 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 12, 97 (2017). https://doi.org/10.1007/s11657-017-0396-2

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  • DOI: https://doi.org/10.1007/s11657-017-0396-2

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