Effect of Sociodemographic Factors on Surgical Consultations and Hip or Knee Replacements among Patients with Osteoarthritis in British Columbia, Canada Rahman, Md Mushfiqur; Kopeć, Jacek A.; Sayre, Eric C.; Greidanus, Nelson; Aghajanian, Jaafar; Anis, Aslam H.; Cibere, Jolanda; Jordan, Joanne M.; Badley, Elizabeth M.
Objectives To quantify the effect of demographic variables and socioeconomic status (SES) on surgical consultation and total joint arthroplasty (TJA) rates among osteoarthritis (OA) patients, using population-based administrative data. Research Design A cohort study was conducted in British Columbia using population data from 1991 to 2004. From April 1996 to March 1998, we have documented 34,420 new OA patients and these patients were followed to March 2004 for their first surgical consultation and TJA. Effects of age, sex, and SES were evaluated by Cox proportional hazards models after adjusting for co-morbidities and pain medication used. Results During a mean 5.5 year follow up period, 7,475 OA patients had their first surgical consultations and 2,814 patients received TJA within a 6 years mean follow up period. Crude hazards ratio (HR) for men compared to women was 1.25 (95% CI, 1.20-1.31) for surgical consultation and was 1.14 (95% CI, 1.06-1.23) for TJA. The interaction between sex and SES was significant. Stratified analysis showed among men, HR of 1.42 (95% CI, 1.27-1.58) and 1.52 (95% CI, 1.26-1.83) for surgical consultations and TJA respectively for the highest SES compared with the lowest SES quintiles. Similar significant results were observed among women. Conclusions Differential access to the health care system exists among patients with OA. Women with OA were less likely than men to see an orthopedic surgeon as well as to obtain a TJA. Patients with higher SES consulted orthopedic surgeons more frequently and received more TJA than those with the lowest SES.
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