title: Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data.
abstract: Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007-11 for all Australians aged ≥40 years.
  
  
  
  Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling.
  
  
  
  During 2007-11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales.
  
  
  
  Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia. sharob@barwonhealth.org.au.|Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia. sharob@barwonhealth.org.au.|Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia. sharob@barwonhealth.org.au.|Epi-Centre for Healthy Aging, IMPACT Strategic Research Centre, Deakin University, (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia. sharob@barwonhealth.org.au.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Brennan-Olsen
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia.|Barwon Orthopaedic Research Unit, Barwon Health, Geelong, Australia.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Page
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia.|Barwon Health Biostatistics Unit, Barwon Health, University Hospital, Geelong, Australia.|School of BioSciences, University of Melbourne, Melbourne, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lane
authors.affiliation: Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lorimer
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Melbourne, Australia.|Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: School of Health and Social Development, Deakin University, Melbourne, Australia.|NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.affiliation: School of Medicine, Deakin University, Geelong, Australia.|NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Melbourne, Australia.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Wluka
authors.affiliation: Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia.|Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia.|NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.
authors.forename: Kerrie M
authors.initials: KM
authors.lastname: Sanders
authors.affiliation: Australian Institute for Musculoskeletal Sciences, The University of Melbourne, St Albans, Australia.|NorthWest Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia.|Department of Medicine, Monash University, Melbourne, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
authors.affiliation: Australian Orthopaedic Association Joint Replacement Registry, Adelaide, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Graves
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000706:statistics & numerical data*; D001315:Australia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D012042:Registries; D012737:Sex Factors; D012785:Shoulder Joint / Q000601:surgery; D012959:Socioeconomic Factors
keywords: Arthroplasty; Australia; Geographic locality; Shoulder joint; Socioeconomic factors