Table 5 Results of studies exploring surgical need
From: Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review
Ref. | Study timeframe | Estimate of surgical need | Socio-demographic domains | Conclusions |
|---|---|---|---|---|
[34] | SASH data: 1994 to 1995 ELSA data: March 2002 to March 2003 | New Zealand score for joint disease severity (proxy score calculated from SASH and ELSA data) | - Age - Gender - Area-based deprivation (IMD 2004) - Occupational social class - Non-white ethnicity and ethnic mix of residence - BMI - Rurality | -After multivariable adjustment, the rate for hip replacement was 31.9 per 10,000 (95% C.I: 28.4–35.8) Age - Rates of need increased with increasing age, with effect reinforced after controlling for obesity Sex - Rates of need are lower in men than in women (95% CI: 0.6–0.9) Deprivation - Lowest social class have the greatest rates of need, however this association is attenuated by deprivation and obesity - Least deprived patients also have greatest rate of need however effect is not as strong as class Ethnicity - Data suggested non-white patients had greater rate of need, however adjustment for the confounders of deprivation and social class eliminated this - Ethnic mix of patient residence is not associated with rate of need Rurality - No association between rurality and rate of need was found Obesity - BMI scores above 30 were a strong predictor for increased rate of need (95% CI: 1.9–2.8) |
[2] | April 2009 to October 2010 | Oxford hip score to determine severity of hip condition Patients asked how long their hip problems been present and which comorbidities they have | - Age - Gender - Area-based deprivation (IMD 2007) - Ethnicity - Duration of symptoms - Comorbidities | Deprivation - More deprived patients had lower mean OHS than less deprived with clear gradient across deprivation quintiles: difference between least and most deprived was 3.6 points (95% CI: 3.4–3.9) - More deprived patients had longer-term hip problems with an odds ratio of 1.11 (95% CI: 1.03–1.20) Gender - Women had mean OHS 2.3 points lower than men (95% CI: 2.2–2.5) - Women also less likely to self-report long-term issues with an odds ratio of 0.96 (95% CI:0.92–1.00) Age - Patients who had hip replacement at atypically young or old age had lower mean OHS: OHS score 1.4 points lower between youngest patients (below 51 years) and patients aged 71-80 years (95% CI: 1.1–1.7) - Duration of hip-related issues declined with age with odds ratio of 4.26 between youngest patients and those aged 71-80 (95% CI: 3.90–4.64) Ethnicity - More severe hip condition in South Asian patients (OHS 2.7 lower) and Black patients (OHS 0.9 lower) than White patients – also had longer-term issues with odds ratio of 1.40 - South Asian and Black patients had lower pre-surgery OHS than White patients, with South Asians having lowest mean OHS (2.7 points lower) (95% CI: 1.5–4.0) - Differences between White and Black patients not statistically significant (mean OHS 0.9 points lower) |
[29] | 2006 to 2007 | Oxford hip score to determine severity of hip condition EQ-5D quality of life questionnaire Patients asked how long their hip problems been present, which comorbidities they have, their overall health status and whether they’ve had similar surgery before | - Age - Gender - Area-based deprivation (IMD 2004) - Comorbidities - Overall health status - Quality of life (EQ-5D) | Deprivation - Mean OHS 3.5 points lower in most deprived patients versus least deprived patients- significant relationship (P < 0.001) - Adjustment for age, sex, health status and comorbidities weaken this relationship: increased p-values and fall in standardised regression coefficients - After adjusting for quality of life (EQ-5D), regression coefficients fall further, however relationship still remains significant (p = 0.02) |