Explaining regional variation in elective hip and knee arthroplasties in Finland 2010 − 2017—a register-based cohort study

Manderbacka, K., Satokangas, M., Arffman, M., Reissell, E., Keskimäki, I. and Leyland, A. H. (2022) Explaining regional variation in elective hip and knee arthroplasties in Finland 2010 − 2017—a register-based cohort study. BMC Health Services Research, 22, 891. (doi: 10.1186/s12913-022-08305-7) (PMID:35810302) (PMCID:PMC9270793)

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Abstract

Background: A persistent research finding in industrialised countries has been regional variation in medical practices including elective primary hip and knee arthroplasty. The aim of the study was to examine regional variations in elective total hip and knee arthroplasties over time, and the proportions of these variations which can be explained by individual level or area-level differences in need. Methods: We obtained secondary data from the Care Register for Health Care to study elective primary hip and knee arthroplasties in total Finnish population aged 25 + years between 2010 and 2017. Two-level Poisson regression models – individuals and hospital regions – were used to study regional differences in the incidence of elective hip and knee arthroplasties in two time periods: 2010 − 2013 and 2014 − 2017. The impact of several individual level explanatory factors (age, socioeconomic position, comorbidities) and area-level factors (need and supply of operations) was measured with the proportional change in variance. Predictions of incidence were measured with incidence rate ratios. The relative differences in risk of the procedures in regions were described with median rate ratios. Results: We found small and over time relatively stable regional variation in hip arthroplasties in Finland, while the variation was larger in knee arthroplasties and decreased during the study period. In 2010 − 2013 individual socioeconomic variables explained 10% of variation in hip and 4% in knee arthroplasties, an effect that did not emerge in 2014 − 2017. The area-level musculoskeletal disorder index reflecting the need for care explained a further 44% of the variation in hip arthroplasties in 2010 − 2013, but only 5% in 2014 − 2017 and respectively 22% and 25% in knee arthroplasties. However, our final models explained the regional differences only partially. Conclusions: Our results suggest that eligibility criteria in total hip and knee arthroplasty are increasingly consistent between Finnish hospital districts. Factors related to individual level and regional level need both had an important role in explaining regional variations. Further study is needed on the effect of health policy on equity in access to care in these operations.

Item Type:Articles
Additional Information:The study was funded by the Strategic Research Council of the Academy of Finland (grant 312 708). AL is funded by the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Leyland, Professor Alastair
Authors: Manderbacka, K., Satokangas, M., Arffman, M., Reissell, E., Keskimäki, I., and Leyland, A. H.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:BMC Health Services Research
Publisher:BioMed Central
ISSN:1472-6963
ISSN (Online):1472-6963
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in BMC Health Services Research 22: 891
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit