From: Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review
Ref. | Study timeframe | Estimate of surgical provision | Socio-demographic domains | Conclusions |
---|---|---|---|---|
[31] | Financial year 1991/2 and financial year 2001/2 | Admissions data from HES | - Age - Gender - Area-based deprivation (Townsend deprivation Z-score for 1991 and 2001 census data) | - 1991 hip replacement rate for adults over 44 years: 160 per 100.000, 2001 hip replacement rate: 184 per 100,000 Deprivation - Decrease in inequality from 1991 to 2001 with increase in usage by most deprived patients (standard utilisation rate: 0.804 to 0.843) and decrease in usage for least deprived patients (1.135 to 1.075) - To bring usage levels of most deprived quintile to the level of least deprived quintile, an increase of use of 41% was required in 1991, falling to 27% in 2001 - Utilisation ratio between most deprived and least deprived patients fell from 1.41 in 1991 (95% CI: 1.36–1.47) to 1.27 in 2001 (95% CI: 1.36–1.47) |
[32] | Financial year 2002/3 | Admissions data from HES | - Age - Gender - Area level deprivation (IMD 2004) - Rurality of residence - Ethnic mix of residence - Hospital variables (number of hip operations, orthopaedic training centre status, rate of consultants, operating theatres and bed occupancy rates | Deprivation - Weak evidence for a trend in relationship between SES and surgical provision Age - In patients aged 50-59, the more deprived patients received more provision, however effects weaken with increasing age – patients aged over 85 had opposite association Gender - Women had greater provision however association was weakest in the oldest and youngest age cohorts – strongest effect in urban areas Ethnicity - No association was found between provision and ethnicity Rurality - Non-urban dwelling patients had greater provision as did those living further away from hospitals Hospital effects - Higher volume of surgeries, more consultants, more anaesthetic consultants and more operating theatres were associated with greater provision Geographical - Certain variables such as gender varied geographically – in some areas men received greater provision, in other areas men receive worse provision |
[4] | April 2003 to December 2012 | Admissions data from HES | - Age - Gender - Area based deprivation (IMD 2010) - Ethnicity - Primary diagnosis - BMI - ASA score - Quality of life (EQ-5D score) | - Provision of surgery for Black and Asian population lower than expected: Odds ratio for Black patients = 0.33 (95% CI: 0.31–0.35), Odds ratio for Asian patients = 0.20 (95% CI: 0.19–0.21) Type of surgery - Black patients were more likely to receive uncemented prostheses compared to cemented prostheses, in all age groups: Odds ratio = 1.43 (95% CI: 1.11–1.84) Deprivation - Ethnic minority patients were younger and lived in areas of greater deprivation than White patients - Ethnic minority patient had better surgical fitness however (lower ASA grade) Gender - Ratio of expected versus observed surgeries was similar in men and women Primary condition - Osteoarthritis was most common primary condition for all ethnicities - Black and Asian patients more likely to have osteonecrosis, inflammatory arthritis or congenital dysplasia as their primary condition, as well as ‘other reasons’ |