title: Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003-10: data from the Australian Orthopaedic Association National Joint Replacement Registry.
abstract: BACKGROUND
  Relatively little is known about the social distribution of total knee joint replacement (TKR) uptake in Australia. We examine associations between socioeconomic status (SES) and TKR performed for diagnosed osteoarthritis 2003-10 for all Australian males and females aged ≥ 30 yr.
  
  
  METHODS
  Data of primary TKR (n=213,018, 57.4% female) were ascertained from a comprehensive national joint replacement registry. Residential addresses were matched to Australian Census data to identify area-level social disadvantage, and categorised into deciles. Estimated TKR rates were calculated. Poisson regression was used to model the relative risk (RR) of age-adjusted TKR per 1,000py, stratified by sex and SES.
  
  
  RESULTS
  A negative relationship was observed between TKR rates and SES deciles. Females had a greater rate of TKR than males. Surgery utilisation was greatest for all adults aged 70-79 yr. In that age group differences in estimated TKR per 1,000py between deciles were greater for 2010 than 2003 (females: 2010 RR 4.32 and 2003 RR 3.67; males: 2010 RR 2.04 and 2003 RR 1.78).
  
  
  CONCLUSIONS
  Identifying factors associated with TKR utilisation and SES may enhance resource planning and promote surgery utilisation for end-stage osteoarthritis.
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia. sbrennan@unimelb.edu.au.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Brennan
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lane
authors.forename: Michelle
authors.initials: M
authors.lastname: Lorimer
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Anita E
authors.initials: AE
authors.lastname: Wluka
authors.forename: Richard S
authors.initials: RS
authors.lastname: Page
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
authors.forename: Kerrie M
authors.initials: KM
authors.lastname: Sanders
authors.forename: Kara
authors.initials: K
authors.lastname: Cashman
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Graves
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery*; D012042:Registries; D012737:Sex Factors; D012923:Social Class