The impact of socioeconomic status on the utilization of total hip arthroplasty during 1995–2017: 104,055 THA cases and 520,275 population controls from national databases in Denmark

Abstract

Background and purpose — In Denmark, all citizens are guaranteed free access to medical care, which should minimize socioeconomic status (SES) inequalities. We examined the association between SES and the utilization of total hip arthroplasty (THA) by age and over time. Patients and methods — Data on education, income, liquid assets, and occupation on 104,055 THA cases and 520,275 population controls were obtained from Danish health registers. We used logistic regression to estimate adjusted odds ratios (aOR) for THA with 95% confidence intervals (CI). Results — Risk (CI) of THA was higher for 45–55-year-olds with lowest vs. highest education (aOR 1.4 [1.3–1.5]), and for those with lowest vs. highest income (aOR 1.1 [1.0–1.2]). The association between education and income and higher risk of THA decreased with increasing age. The risk of THA was lower for persons with lowest vs. highest liquid assets in all age groups and time periods. The risk of THA was higher for persons with lowest education in 1995–2000 (aOR 1.2 [1.1-1.3]), but diminished in 2013–2017 (aOR 1.0 [1.0–1.0]). For those on lowest income there was a higher risk of THA in 1995–2000 (aOR 1.2 [1.1–1.3]), changing to lower risk in 2013–2017 (aOR 0.8 [0.8–0.9]). Interpretation — In a society where all citizens are guaranteed free access to medical care, we observed a social inequality in regard to the risk of THA with a development over time and in relation to age in most of our SES markers, showing a need for more patient involvement by implementing more focused interventions targeted to the most vulnerable patient groups identified as currently living alone, on low income, and with a low level of liquid assets.

Impact of socioeconomic status on the 90- and 365-day rate of revision and mortality after primary total hip arthroplasty: a cohort study based on 103,901 patients with osteoarthritis from national databases in Denmark

“…Socioeconomic inequality in health is increasingly recognized as an important public health issue (Agabiti et al 2007). Socioeconomic status (SES) is associated with access to total hip arthroplasty (THA) and with greater vulnerability to complications after THA, all in favor of high status (Agabiti et al 2007, Weiss et al 2019, Edwards et al 2021. However, few studies have investigated the impact of SES on the risk of revision and mortality and they all present contradicting results, from showing that low SES was associated with a higher risk of early mortality after a THA, to finding no association among SES, revision, and mortality (Mahomed et al 2003, Agabiti et al 2007, Jenkins et al 2009, Peltola and Järvelin 2014, Maradit Kremers et al 2015.…”

Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts

“…There has been evidence of poorer outcomes after arthroplasty among people with poorer socioeconomic circumstances. Edwards et al highlighted a social gradient in the demand for THA in Denmark 33. They found that the demand for THA was highest among those of lowest educational attainment and lowest household incomes among people aged 45–55 years, effects that diminished with increasing age 33.…”

Impact of valvular heart disease on hip replacement: a retrospective nationwide inpatient sample database study

“…In one study among the older adult population over the age of 75 years, the proportion of severe AS cases found the low-income populations have increased potential need for THA [12][13][14]. Additionally, it may reflect that AS patients were not welcomed by orthopedists or the contribution of AS to mortality and morbidity might have been ignored in the orthopedics department.…”