title: Effect of sociodemographic factors on surgical consultations and hip or knee replacements among patients with osteoarthritis in British Columbia, Canada.
abstract: OBJECTIVE
  To quantify the effect of demographic variables and socioeconomic status (SES) on surgical consultation and total joint arthroplasty (TJA) rates among patients with osteoarthritis (OA), using population-based administrative data.
  
  
  METHODS
  A cohort study was conducted in British Columbia using population data from 1991 to 2004. From April 1996 to March 1998, we documented 34,420 new patients with OA and these patients were followed to March 2004 for their first surgical consultation and TJA. Effects of age, sex, and SES were evaluated by Cox proportional hazards models after adjusting for comorbidities and pain medication used.
  
  
  RESULTS
  During a mean 5.5-year followup period, 7475 patients with OA had their first surgical consultations and 2814 patients received TJA within a 6-year mean followup period. Crude hazards ratio (HR) for men compared to women was 1.25 (95% CI 1.20-1.31) for surgical consultation and was 1.14 (95% CI 1.06-1.23) for TJA. The interaction between sex and SES was significant. Stratified analysis showed among men an HR of 1.42 (95% CI 1.27-1.58) and 1.52 (95% CI 1.26-1.83) for surgical consultations and TJA, respectively, for the highest SES compared with the lowest SES quintiles. Similarly significant results were observed among women.
  
  
  CONCLUSIONS
  Differential access to the healthcare system exists among patients with OA. Women with OA were less likely than men to see an orthopedic surgeon as well as to obtain TJA. Patients with higher SES consulted orthopedic surgeons more frequently and received more TJA than those with the lowest SES.
authors.affiliation: Arthritis Research Centre of Canada, Vancouver, BC V5Z 1L7, Canada. mrahman@arthritisresearch.ca
authors.forename: M Mushfiqur
authors.initials: MM
authors.lastname: Rahman
authors.forename: Jacek A
authors.initials: JA
authors.lastname: Kopec
authors.forename: Eric C
authors.initials: EC
authors.lastname: Sayre
authors.forename: Nelson V
authors.initials: NV
authors.lastname: Greidanus
authors.forename: Jaafar
authors.initials: J
authors.lastname: Aghajanian
authors.forename: Aslam H
authors.initials: AH
authors.lastname: Anis
authors.forename: Jolanda
authors.initials: J
authors.lastname: Cibere
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Jordan
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000601:surgery*; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012737:Sex Factors; D012923:Social Class; D055815:Young Adult