title: Sociodemographic differences in the severity and duration of disease amongst patients undergoing hip or knee replacement surgery.
abstract: BACKGROUND
  Differences in the use of hip and knee replacement by sex, age, ethnicity or socioeconomic status may lead to differences in disease severity between those who have surgery.
  
  
  METHODS
  Analyses used data collected from 117,736 patients in 2009-10 via the Patient Reported Outcome Measures (PROMs) programme in England. Adjusted differences were estimated in the Oxford Hip Score (OHS) or the Oxford Knee Score (OKS), both expressed on a scale from 0 to 48, and the proportion with longstanding problems (>5 years), expressed as odds ratios (ORs).
  
  
  RESULTS
  Women had more severe pain and disability than men on average (difference OHS 2.3 and OKS 3.3), but less often longstanding problems. Compared with white patients, average severity was higher in South Asian patients (difference OHS 2.7 and OKS 3.0) and in black patients (difference OHS 0.9 and OKS 1.6), who also more often had longstanding problems (OR 1.40 for hip and 1.54 for knee). Patients from deprived areas had more severe disease (difference OHS 3.6 and OKS 3.3 between least and most deprived quintile).
  
  
  CONCLUSIONS
  There is evidence that non-white and deprived patients tend to have hip and knee replacement surgery at a later stage in the course of their disease.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. jenny.neuburger@lshtm.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Neuburger
authors.forename: A
authors.initials: A
authors.lastname: Hutchings
authors.forename: D
authors.initials: D
authors.lastname: Allwood
authors.forename: N
authors.initials: N
authors.lastname: Black
authors.forename: J H
authors.initials: JH
authors.lastname: van der Meulen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003657:Decision Making; D003710:Demography; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012720:Severity of Illness Index; D012923:Social Class; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology