title: Equity of publicly-funded hip and knee joint replacement surgery in New Zealand: results from a national observational study.
abstract: OBJECTIVE
  This study examines equity in the provision of publicly-funded hip and knee total joint replacement (TJR) surgery in New Zealand between 2006 and 2013 to: 1) investigate national rates by demographic characteristics; 2) describe changes in national rates over time; and 3) compare rates of provision between District Health Boards (DHBs).
  
  
  METHODS
  Hospital discharge data for people aged 20 years or over who had at least one hip or knee TJR between 2006 and 2013 was obtained from the Ministry of Health's National Minimum Dataset.
  
  
  RESULTS
  Higher TJR rates were observed among those aged 75-84 years, females, those of Māori ethnicity, those not living in rural or main urban areas and those in the most deprived socio-economic groups. TJRs increased from 7,053 in 2006 to 8,429 in 2013, however the rate was highest in 2007. In 2012-13, age-ethnicity-standardised rates varied between DHBs from 196 to 419/100,000 person years, with larger DHBs having lower rates than smaller DHBs.
  
  
  CONCLUSIONS
  There was evidence of geographic inequity in TJR provision across New Zealand. Despite increased numbers of procedures, rates of publicly-funded TJR surgery are barely keeping up with population increases. Reasons behind differences in provision should be examined.
authors.affiliation: Lecturer, Preventive and Social Medicine, University of Otago, Dunedin.
authors.forename: Helen
authors.initials: H
authors.lastname: Harcombe
authors.affiliation: Senior Research Fellow, Preventive and Social Medicine, University of Otago, Dunedin.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Davie
authors.affiliation: Associate Professor, Preventive and Social Medicine, University of Otago, Dunedin.
authors.forename: Sarah
authors.initials: S
authors.lastname: Derrett
authors.affiliation: Research Associate Professor, Department of Surgical Sciences, University of Otago, Dunedin.
authors.forename: Haxby
authors.initials: H
authors.lastname: Abbott
authors.affiliation: Associate Professor, Department of Surgical Sciences, University of Otago, Dunedin.
authors.forename: David
authors.initials: D
authors.lastname: Gwynne-Jones
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data* / Q000639:trends; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data* / Q000639:trends; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult