ArticleBMJ (Clinical research ed.)2010
Equity in access to total joint replacement of the hip and knee in England: cross sectional study.
Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
59 citing papers in PubMed, 6 syntheses or guidelines pooled it, 147 citations in OpenAlex.
- Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review.International journal for equity in health · 2021Pooled it
- Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis.BMJ open · 2018Pooled it
- Identifying inequitable healthcare in older people: systematic review of current research practice.International journal for equity in health · 2017Pooled it
- [Personality and comorbidity: are there "difficult patients" in hip arthroplasty?].Der Orthopade · 2015Pooled it
- Determinants of demand for total hip and knee arthroplasty: a systematic literature review.BMC health services research · 2012Pooled it
- Drivers of surgery for the degenerative hip, knee, and spine: a systematic review.Clinical orthopaedics and related research · 2012Pooled it
- Incidence of Total Knee Arthroplasty After Arthroscopic Surgery for Knee Osteoarthritis: A Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2024Trial
- Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement: an assessor-blinded randomized controlled trial.BMC musculoskeletal disorders · 2015Trial
- Trial
- Establishing a Per-Hour Rate for Early-Career Adult Reconstruction Surgeons Performing Medicare Primary Total Joint Arthroplasty.Arthroplasty today · 2024Article
- The Trend of Medicare Reimbursement for Total Joint Arthroplasty: Using Mathematical Models to Predict Possible Per-Hour Rate Out to 2030.Arthroplasty today · 2024Article
- Lower Income and Nonheterosexual Orientation Are Associated With Poor Access to Care in Patients With Knee Osteoarthritis.Arthroplasty today · 2024Article
- What recovery domains are important following a total knee replacement? A qualitative, interview-based study.BMJ open · 2024Article
- Total Hip Arthroplasty in Chile Is Characterized By Low Utilization Rates and Disparity in Access.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2024Article
- Health equity profile of knee replacement patients in the South African public sector: A descriptive study.The South African journal of physiotherapy · 2024Article
- Hip arthroplasty practice across the Organisation for Economic Co-operation and Development (OECD) over the last decade.Annals of the Royal College of Surgeons of England · 2023Article
- Adaptation and Implementation of a Shared Decision-Making Tool From One Health Context to Another: Partnership Approach Using Mixed Methods.Journal of medical Internet research · 2023Article
- Article
- Equity of access to NHS-funded hip replacements in England and Wales: Trends from 2006 to 2016.The Lancet regional health. Europe · 2022Article
- Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies.Journal of the Royal Society of Medicine · 2022Article
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveTo explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery.
designCombining small area estimates of need and provision to explore equity in access to care.
settingEnglish census wards. SUBJECTS: Patients throughout England who needed total hip or knee replacement and numbers who received surgery.
main outcome measuresPredicted rates of need (derived from the Somerset and Avon Survey of Health and English Longitudinal Study of Ageing) and provision (derived from the hospital episode statistics database). Equity rate ratios comparing rates of provision relative to need by sociodemographic, hospital, and distance variables.
resultsFor both operations there was an "n" shaped curve by age. Compared with people aged 50-59, those aged 60-84 got more provision relative to need, while those aged >or=85 received less total hip replacement (adjusted rate ratio 0.68, 95% confidence interval 0.65 to 0.72) and less total knee replacement (0.87, 0.82 to 0.93). Compared with women, men received more provision relative to need for total hip replacement (1.08, 1.05 to 1.10) and total knee replacement (1.31, 1.28 to 1.34). Compared with the least deprived, residents in the most deprived areas got less provision relative to need for total hip replacement (0.31, 0.30 to 0.33) and total knee replacement (0.33, 0.31 to 0.34). For total knee replacement, those in urban areas got higher provision relative to need, but for total hip replacement it was highest in villages/isolated areas. For total knee replacement, patients living in non-white areas received more provision relative to need (1.04, 1.00 to 1.07) than those in predominantly white areas, but for total hip replacement there was no effect. Adjustment for hospital characteristics did not attenuate the effects.
conclusionsThere is evidence of inequity in access to total hip and total knee replacement surgery by age, sex, deprivation, rurality, and ethnicity. Adjustment for hospital and distance did not attenuate these effects. Policy makers should examine factors at the level of patients or primary care to understand the determinants of inequitable provision.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.