title: Gender inequity in the provision of care for hip disease: population-based cross-sectional study.
abstract: OBJECTIVE
  To examine gender differences along the care pathway to total hip replacement.
  
  
  METHODS
  We conducted a population-based cross-sectional study of 26,046 individuals aged 35 years and over in Avon and Somerset. Participants completed a questionnaire asking about care provision at five milestones on the pathway to total hip replacement. Those reporting hip disease were invited to a clinical examination. We estimated odds ratios (ORs) [95% confidence intervals (CI)] for provision of care to women compared with men.
  
  
  RESULTS
  3169 people reported hip pain, 2018 were invited for clinical examination, and 1405 attended (69.6%). After adjustment for age and disease severity, women were less likely than men to have consulted their general practitioner (OR 0.78, 95%-CI 0.61-1.00), as likely as men to have received drug therapy for hip pain in the previous year (OR 0.96, 95%-CI 0.74-1.24), but less likely to have been referred to specialist care (OR 0.53, 95%-CI 0.40-0.70), to have consulted an orthopaedic surgeon (OR 0.50, 95%-CI 0.32-0.78), or to be on a waiting list for total hip replacement (OR 0.41, 95%-CI 0.20-0.87). Differences remained in the 746 people who had sought care from their general practitioner, and after adjustment for willingness and fitness for surgery.
  
  
  CONCLUSIONS
  There are gender inequalities in provision of care for hip disease in England, which are not fully accounted for by gender differences in care seeking and treatment preferences. Differences in referral to specialist care by general practitioners might unwittingly contribute to this inequity. Accurate information about availability, benefits and risks of hip replacement for providers and patients, and continuing education to ensure that clinicians interpret and correct patients' assumptions could help reduce inequalities.
authors.affiliation: Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Jüni
authors.forename: N
authors.initials: N
authors.lastname: Low
authors.forename: S
authors.initials: S
authors.lastname: Reichenbach
authors.forename: P M
authors.initials: PM
authors.lastname: Villiger
authors.forename: S
authors.initials: S
authors.lastname: Williams
authors.forename: P A
authors.initials: PA
authors.lastname: Dieppe
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019091:Critical Pathways / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012044:Regression Analysis; D012737:Sex Factors