Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas

Mark L Francis; Steven L Scaife; Whitney E Zahnd; E Francis Cook; Sebastian Schneeweiss

doi:10.1002/art.25004

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Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas

Journal article

Open access

Peer reviewed

Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas

Mark L Francis, Steven L Scaife, Whitney E Zahnd, E Francis Cook and Sebastian Schneeweiss

Arthritis and rheumatism, Vol.60(12), pp.3554-3562

12/2009

DOI: 10.1002/art.25004

PMID: 19950278

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Abstract

People in rural areas live farther away from hospitals than do people in urban areas. Thus, there is concern that people living in rural areas may be less willing or able to undergo elective surgical procedures. This study was undertaken to determine whether Medicare beneficiaries in rural areas were less likely to have elective total knee or hip replacement surgeries compared with their urban counterparts. We performed a cross-sectional study of Medicare beneficiaries, controlling for age, sex, race/ethnicity, and economic status. Beneficiaries were assigned to rural versus urban areas based on their zip code of residence and the 10-point Rural-Urban Commuting Area designation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Compared with urban beneficiaries, rural beneficiaries were 27% more likely to have total knee or hip replacement surgeries (OR 1.27 [95% CI 1.26-1.28]). After adjusting for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence, rural beneficiaries were still 14% more likely to have total joint replacement surgeries (OR 1.14 [95% CI 1.13-1.16]). Differential use of surgery before and after receiving Medicare eligibility did not explain the findings. While significant sex, racial, and ethnic disparities were present in both rural and urban areas, for the most part these disparities were ameliorated rather than accentuated in rural areas. Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries.

Aged

Arthritis - ethnology

Arthritis - surgery

Arthroplasty, Replacement, Hip - statistics & numerical data

Arthroplasty, Replacement, Knee - statistics & numerical data

Cross-Sectional Studies

Female

Health Services Accessibility - statistics & numerical data

Healthcare Disparities - statistics & numerical data

Humans

Male

Medicare - statistics & numerical data

Rural Health - statistics & numerical data

Socioeconomic Factors

United States - ethnology

Urban Health - statistics & numerical data

Details

Title: Subtitle: Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas
Creators: Mark L Francis - Southern Illinois University School of Medicine, Springfield, IL 62794-9636, USA. mfrancis@siumed.edu
Steven L Scaife
Whitney E Zahnd
E Francis Cook
Sebastian Schneeweiss
Resource Type: Journal article
Publication Details: Arthritis and rheumatism, Vol.60(12), pp.3554-3562
DOI: 10.1002/art.25004
PMID: 19950278
NLM abbreviation: Arthritis Rheum
ISSN: 0004-3591
eISSN: 1529-0131
Publisher: Wiley
Language: English
Date published: 12/2009
Academic Unit: Health Management and Policy
Record Identifier: 9984214959202771

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