From: Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review
Ref. | Study timeframe | Estimate of surgical need | Estimate of surgical provision | Socio-demographic domains | Conclusions |
---|---|---|---|---|---|
[27] | January 1997 to December 2007 | n/a | Waiting time until hip replacement from initial specialist referral to surgery | - Age - Gender - Area-based deprivation (Carstairs index of deprivation) - Rurality of patient residence - Provider of care (private, foundation trust, teaching hospital, specialist hospital, traditional NHS) | - Statistically significant reduction in waiting time with the following successive time periods:1997-2000, 2001-4, and 2005-7 Deprivation - Positive association between deprivation and waiting times in 1997 - From 1997 to 2000, successive increases in deprivation quintile (least deprived ➔ most deprived) were associated with significant increase in waiting time by 1-2 weeks (P < 0.001) - From 2001 to 2004, there was large variation in waiting time between deprivation quintiles with middle quintile patients waiting longest - From 2005 to 2007, there was little association between deprivation quintile and waiting time - Waiting times had more of a uniform distribution by 2007 - Variation in waiting time in relation to socioeconomic group decreased over time |
[1] | SASH data: 1994 to 1995 ELSA data: March 2002 to March 2003 HES data: 2001/2 financial year | New Zealand score for joint disease severity (proxy score calculated from SASH and ELSA data) Patients scoring below 48/80 on New Zealand score excluded | Admissions data from HES | - Age - Gender - Area-based deprivation (2004 IMD) - Ethnic mix of patient residence - Rurality - Distance travelled to receive care - Primary diagnosis - Hospital variables (number of hip operations, orthopaedic training centre status, rate of consultants, and operating theatres | - Low provision to need ratio -- For every 1000 patients in need of surgery, 44 will be operated on Deprivation - In order to move to middle deprivation quintile, hospitals in most deprived quintile need to perform 24 additional surgeries per 1000 patients - Patients in most deprived quintile had lower need to provision ratios than those in least deprived quintile (95% C.I: 0.30–0.33) - Patients in most deprived quintile had 70% lower provision to need ratios than those in least deprived quintile Geographical/Rurality - Need to provision ratios lowest in north England, West Midlands and London - Highest ratios in south England (except London) - People in more rural areas (village/isolated) had highest need to provision ratios – longer road travel times also had greater provision - Town and fringe areas had lowest need to provision ratios Gender - Men had lower need to provision ratios compared to women, receiving 8% more surgeries (95% C.I: 1.05–1.10) Hospital effects - Higher volume of surgeries, orthopaedic training centre status, more orthopaedic consultants and more operating theatres were associated with higher need to provision ratio Ethnicity - No effect on access seen with ethnic mix of patient residence |
[30] | 2001/2 financial year | n/a | Waiting time until hip replacement from initial specialist referral to surgery (calculated from HES data) | - Age - Gender - Area-based deprivation (2004 IMD) - Number of diagnoses at hospital admission - Primary diagnosis - Hospital fixed effects | Deprivation - Least deprived patients (educationally) wait 12.8 –13.6% less than patients from bottom 3 deprivation quintiles - Most deprived patients (income) wait 7.5% longer than patients from the least deprived quintile Age - Patients over 75 years wait 17-30% less than patients aged 45-54 Gender - Male patients wait 3.5% longer than women Primary diagnosis - Patients with rheumatoid arthritis or osteonecrosis experience shorter waiting times than arthrosis patients: 27% and 45-53% less respectively Hospital effects - 14% of waiting time variation are as a result of hospital-level differences |
[35] | 2002 to 2009 | Hip replacement rates standardised (per area and per year) to national age-sex specific hip replacement rates for specific year | Admissions data from NHS hospitals | - Age - Gender - Area-based deprivation | - Mean rate of hip replacement for 2009: 20.2 per 10,000 Deprivation - Patients from least deprived quintile receive 5.68 more hip replacements per 10,000 than the most deprived quintile (35% more likely) (95% CI: 5.18–6.18) - Relative increase in age-sex adjusted inequality ratio from 1.23 to 1.35 between 2002 and 2009 (12% increase) (CI 1.25–1.45) |
[36] | SMR data: April 1998 to March 2008 ISD data: financial year 2002/3 and 2007/8 | n/a | Admissions and data on patient waiting times from SMR | - Age - Gender - Area-based deprivation (Scottish IMD 2006) | - Number of hip replacements increased by 42% from 4095 in 2002-2003 to 5829 in 2007-2008 - Proportion of NHS-funded surgeries undertaken in private hospitals rose from 1.1% in 2002-2003 to 2.9% in 2007-2008 Deprivation - Most deprived quintile had least amount of hip replacements compared to least deprived - 82.8 per 100,000 (95% C.I: 79.2–86.3) for most deprived in 1998-2003 versus 95.3 per 100,000 (95% C.I:91.5–99.0) for least deprived - No significant change in socioeconomic inequality from 1998 to 2008 (p = 0.108) Geographical -Significant reduction in geographical inequality (p < 0.001) from 1998 to 2008 |