title: Variation in rates of hip and knee joint replacement in Australia based on socio-economic status, geographical locality, birthplace and indigenous status.
abstract: BACKGROUND
  Our understanding of the incidence of joint replacement across different subgroups of the Australian population is limited. This study investigated whether rates of hip and knee joint replacement vary according to socio-economic status, geographical locality, birthplace and indigenous status.
  
  
  METHODS
  Data from the National Hospital Morbidity Database were obtained. All separations for primary hip or knee joint replacement with the principal diagnosis of arthritis were identified. Age-standardized procedure rates were compared based on socio-economic status, geographical locality, birthplace and indigenous status.
  
  
  RESULTS
  Compared with age- and gender-matched individuals, rates of joint replacement overall were significantly lower in people living in the most disadvantaged (P < 0.05) and remote areas (P < 0.001), people born outside Australia (P < 0.05) and indigenous people (P < 0.001). However, there were some exceptions. Knee replacement rates were higher in the most disadvantaged areas than in the least disadvantaged areas (P < 0.01), and both hip and knee replacement rates were higher in regional areas than in major cities (P < 0.05). Males and females born in New Zealand and females born in the United Kingdom, Ireland and parts of Europe had a greater rate of hip replacement, and females from North Africa and the Middle East had a greater rate of knee replacement, than Australia-born people (P < 0.001).
  
  
  CONCLUSIONS
  There is significant variation in the rates of primary total hip and knee replacement in Australia. Further investigation is needed to determine whether this simply reflects patterns of disease and disease risk factors, or is because of inequalities in health care, unmet need, and/or surgical or patient-related factors.
authors.affiliation: Australian Institute of Health and Welfare, Canberra, Australian Capital Territory.
authors.forename: Tracy
authors.initials: T
authors.lastname: Dixon
authors.forename: Donna M
authors.initials: DM
authors.lastname: Urquhart
authors.forename: Patricia
authors.initials: P
authors.lastname: Berry
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Bhatia
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Wang
authors.forename: Stephen
authors.initials: S
authors.lastname: Graves
authors.forename: Flavia M
authors.initials: FM
authors.lastname: Cicuttini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000453:epidemiology / Q000208:ethnology; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000208:ethnology; D010342:Patient Acceptance of Health Care; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors