title: Inequalities in accessing hip joint replacement for people in need.
abstract: OBJECTIVE
  To quantify the effects of rurality and socio-economic disadvantage on prior evidence of need for total hip joint replacement and use of health services after adjusting for age and gender.
  
  
  METHODS
  Self-completion validated questionnaire mailed directly to subjects.
  
  
  METHODS
  Geographical areas covered by Wiltshire and Sheffield Health Authorities in England.
  
  
  METHODS
  Random stratified sample of 15,000 aged 65 years and over taken from the central age-sex registers.
  
  
  METHODS
  Prior need for hip joint replacement surgery and whether general practice and hospital services were being used as assessed by the questionnaire.
  
  
  RESULTS
  The response rate was 78% after three mailings. Prevalence of need for total hip replacement in the over 64s was 3.4% (95% confidence interval is 3.0% to 3.8%) and in those without co-morbidity 5.4% (95% confidence interval is 4.8% to 6.0%). There were inequalities demonstrated due to age, geography, and deprivation, but not rurality in accessing general practice and hospital services. People who were poor had more need. Older people in need were less likely to be accessing health services.
  
  
  CONCLUSIONS
  There is an important unmet need for hip joint replacement in older people with marked inequalities in levels of need and use of services. The use of numbers of people waiting as a performance indicator is perverse for this procedure. We have urgently to expand orthopaedic services and the training of orthopaedic surgeons in England.
authors.affiliation: Department of Medical Sciences, University of Bath, UK. philip.milner@agwsha.nhs.uk
authors.forename: P C
authors.initials: PC
authors.lastname: Milner
authors.forename: J N
authors.initials: JN
authors.lastname: Payne
authors.forename: R C
authors.initials: RC
authors.lastname: Stanfield
authors.forename: P A
authors.initials: PA
authors.lastname: Lewis
authors.forename: C
authors.initials: C
authors.lastname: Jennison
authors.forename: C
authors.initials: C
authors.lastname: Saul
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012935:Social Justice; D006113:United Kingdom