title: Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas.
abstract: OBJECTIVE
  People in rural areas live farther away from hospitals than do people in urban areas. Thus, there is concern that people living in rural areas may be less willing or able to undergo elective surgical procedures. This study was undertaken to determine whether Medicare beneficiaries in rural areas were less likely to have elective total knee or hip replacement surgeries compared with their urban counterparts.
  
  
  METHODS
  We performed a cross-sectional study of Medicare beneficiaries, controlling for age, sex, race/ethnicity, and economic status. Beneficiaries were assigned to rural versus urban areas based on their zip code of residence and the 10-point Rural-Urban Commuting Area designation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
  
  
  RESULTS
  Compared with urban beneficiaries, rural beneficiaries were 27% more likely to have total knee or hip replacement surgeries (OR 1.27 [95% CI 1.26-1.28]). After adjusting for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence, rural beneficiaries were still 14% more likely to have total joint replacement surgeries (OR 1.14 [95% CI 1.13-1.16]). Differential use of surgery before and after receiving Medicare eligibility did not explain the findings. While significant sex, racial, and ethnic disparities were present in both rural and urban areas, for the most part these disparities were ameliorated rather than accentuated in rural areas.
  
  
  CONCLUSIONS
  Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries.
authors: Southern Illinois University School of Medicine, Springfield, IL 62794-9636, USA. mfrancis@siumed.edu
authors: Mark L
authors: ML
authors: Francis
authors: Steven L
authors: SL
authors: Scaife
authors: Whitney E
authors: WE
authors: Zahnd
authors: E Francis
authors: EF
authors: Cook
authors: Sebastian
authors: S
authors: Schneeweiss
mesh_terms: D000368:Aged; D001168:Arthritis / Q000208:ethnology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000208:ethnology; D014504:Urban Health / Q000706:statistics & numerical data*