English survey shows wide disparity in joint replacement rates
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《英国医生杂志》
Rates of joint replacement surgery in England vary significantly across regions, a new report says.
The number of procedures per 100 000 people was as much as 30% higher in some regions than in others. "Our data suggest that there are inequalities, and probably inequities, in the provision of joint replacements in England," says the report, which was published ahead of print publication on 29 September in Public Health (www.sciencedirect.com, doi: 10.1016/j.puhe.2005.06.003).
"We believe that there is an urgent need for the development of consensus on the indications for these operations and of local appropriateness criteria that could be used to examine inequities and their causes," wrote the authors, from the Department of Social Medicine at the University of Bristol.
Total hip and knee joint replacements are effective treatments for people with severe arthritis, but the authors say there are no clear indications for interventions, making it difficult to examine the appropriateness of surgery in individuals or groups.
"Demand for these operations appears to be increasing as our population ages, and there are continuing concerns about the ability of supply to meet these demands in the UK," they wrote.
In their research the authors used the English hospital episodes statistics to calculate age standardised procedure rates. The results show that in 2000 in England a total of 47 932 hip replacements and 35 939 knee procedures were carried out, though the rates varied substantially from region to region.
For both hip and knee replacement the rates were highest in the South West and West Midlands and lowest in the North West, South East, and London. For knee procedures regional variations were different for men and women: among men Trent had the highest rate and London the lowest, while among women the rate was highest in the West Midlands and lowest in the North West.
The regional variability decreased between 1991 and 2000 but remained high: "In 2000, the highest rates were still about 25-30% higher than those in regions with the lowest rates," says the report.
Higher procedure rates tended to occur in regions with a smaller total population, a larger proportion of elderly residents, a higher proportion of the working age population in manual social classes, and fewer centres offering joint replacement.
The authors wrote: "Given the lack of consensus on indications, it is perhaps not surprising that individual surgeon enthusiasm for the procedures was found to be an important explanatory variable in one study, whilst variations in the willingness of people to consider surgery appeared to explain variations in provision rates in another study."
The authors, who caution that the absence of data from the private sector means that an estimated 20% to 30% of procedures are missing from the analyses, conclude, "English regional variations in total joint replacement provision remain large, are not easily explained, and differ for hips and knees."(Abergavenny Roger Dobson)
The number of procedures per 100 000 people was as much as 30% higher in some regions than in others. "Our data suggest that there are inequalities, and probably inequities, in the provision of joint replacements in England," says the report, which was published ahead of print publication on 29 September in Public Health (www.sciencedirect.com, doi: 10.1016/j.puhe.2005.06.003).
"We believe that there is an urgent need for the development of consensus on the indications for these operations and of local appropriateness criteria that could be used to examine inequities and their causes," wrote the authors, from the Department of Social Medicine at the University of Bristol.
Total hip and knee joint replacements are effective treatments for people with severe arthritis, but the authors say there are no clear indications for interventions, making it difficult to examine the appropriateness of surgery in individuals or groups.
"Demand for these operations appears to be increasing as our population ages, and there are continuing concerns about the ability of supply to meet these demands in the UK," they wrote.
In their research the authors used the English hospital episodes statistics to calculate age standardised procedure rates. The results show that in 2000 in England a total of 47 932 hip replacements and 35 939 knee procedures were carried out, though the rates varied substantially from region to region.
For both hip and knee replacement the rates were highest in the South West and West Midlands and lowest in the North West, South East, and London. For knee procedures regional variations were different for men and women: among men Trent had the highest rate and London the lowest, while among women the rate was highest in the West Midlands and lowest in the North West.
The regional variability decreased between 1991 and 2000 but remained high: "In 2000, the highest rates were still about 25-30% higher than those in regions with the lowest rates," says the report.
Higher procedure rates tended to occur in regions with a smaller total population, a larger proportion of elderly residents, a higher proportion of the working age population in manual social classes, and fewer centres offering joint replacement.
The authors wrote: "Given the lack of consensus on indications, it is perhaps not surprising that individual surgeon enthusiasm for the procedures was found to be an important explanatory variable in one study, whilst variations in the willingness of people to consider surgery appeared to explain variations in provision rates in another study."
The authors, who caution that the absence of data from the private sector means that an estimated 20% to 30% of procedures are missing from the analyses, conclude, "English regional variations in total joint replacement provision remain large, are not easily explained, and differ for hips and knees."(Abergavenny Roger Dobson)