Utilisation of primary total knee joint replacements across socioeconomic status in the Barwon Statistical Division, Australia, 2006–2007: a cross-sectional study

doi:10.1136/bmjopen-2012-001310

BMJ Open. 2012; 2(5): e001310.

Published online 2012 October 3. doi: 10.1136/bmjopen-2012-001310

PMCID: PMC3488757

Utilisation of primary total knee joint replacements across socioeconomic status in the Barwon Statistical Division, Australia, 2006–2007: a cross-sectional study

Sharon Lee Brennan,^1,^2,³ Tyman Stanford,⁴ Anita E Wluka,⁵ Richard S Page,⁶ Stephen E Graves,⁷ Mark A Kotowicz,^1,^2,⁸ Geoffrey C Nicholson,^1,⁹ and Julie A Pasco^1,²

¹NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Victoria, Australia

²Barwon Epidemiology and Biostatistics Unit, School of Medicine, Deakin University, Geelong, Australia

³Australian Institute of Musculo-Skeletal Science, NorthWest Academic Centre, The University of Melbourne, St Albans, Victoria, Australia

⁴Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia

⁵Department of Epidemiology and Preventive Medicine, School of Preventive Medicine, Monash University, Melbourne, Australia

⁶Barwon Orthopaedic Research Unit, Barwon Health, Geelong, Australia

⁷Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia

⁸Department of Endocrinology and Diabetes, Barwon Health, Geelong, Australia

⁹Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, Australia

^{Correspondence to} Dr Sharon L Brennan; Email: sbrennan/at/unimelb.edu.au

Received April 13, 2012; Accepted August 2, 2012.

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Abstract

Objectives

There are few Australian data that examine the association between total knee joint replacement (TKR) utilisation and socioeconomic status (SES). This study examined TKR surgeries with a diagnosis of osteoarthritis (OA) performed for residents of Barwon Statistical Division (BSD) for 2006–2007.

Design

Cross-sectional.

Setting

BSD, South-eastern Victoria, Australia

Participants

All patients who underwent a TKR for OA, 2006–2007, and whose residential postcode was identified as within the BSD of Australia, and for whom SES data were available, were eligible for inclusion.

Primary outcome measure

Primary TKR data ascertained from the Australian Orthopaedic Association National Joint Replacement Registry. Residential addresses were matched with the Australian Bureau of Statistics census data, and the Index of Relative Socioeconomic Disadvantage was used to determine SES, categorised into quintiles whereby quintile 1 indicated the most disadvantaged and quintile 5 the least disadvantaged. Age-specific and sex-specific rates of TKR utilisation per 1000 person-years were reported for 10-year age bands.

Results

Females accounted for 62.7% of the 691 primary TKR surgeries performed during 2006–2007. The greatest utilisation rates of TKR in males was 7.6 observed in those aged >79 years, and in 10.2 in females observed in those aged 70–79 years. An increase in TKR was observed for males in SES quintile four compared to quintile 1 in which the lowest utilisation which was observed (p=0.04). No differences were observed in females across SES quintiles.

Conclusions

Further investigation is warranted on a larger scale to examine the role that SES may play in TKR utilisation, and to determine whether any social disparities in TKR utilisation reflect health system biases or geographic differences.

Keywords: RHEUMATOLOGY, SOCIAL MEDICINE, EPIDEMIOLOGY

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