The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study
Identifieur interne : 000A43 ( Istex/Corpus ); précédent : 000A42; suivant : 000A44The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study
Auteurs : Nera Agabiti ; Sally Picciotto ; Giulia Cesaroni ; Luigi Bisanti ; Francesco Forastiere ; Roberta Onorati ; Barbara Pacelli ; Paolo Pandolfi ; Antonio Russo ; Teresa Spadea ; Carlo A. PerucciSource :
- International Journal for Quality in Health Care [ 1353-4505 ] ; 2007-02.
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- KwdEn :
Abstract
Objective. In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. Design. Multicity population-based longitudinal study. Settings and participants. From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997–2000. Main outcome measures. An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. Results. Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81–0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66–0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. Conclusions. Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.
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DOI: 10.1093/intqhc/mzl065
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title><author><name sortKey="Agabiti, Nera" sort="Agabiti, Nera" uniqKey="Agabiti N" first="Nera" last="Agabiti">Nera Agabiti</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Picciotto, Sally" sort="Picciotto, Sally" uniqKey="Picciotto S" first="Sally" last="Picciotto">Sally Picciotto</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Cesaroni, Giulia" sort="Cesaroni, Giulia" uniqKey="Cesaroni G" first="Giulia" last="Cesaroni">Giulia Cesaroni</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Bisanti, Luigi" sort="Bisanti, Luigi" uniqKey="Bisanti L" first="Luigi" last="Bisanti">Luigi Bisanti</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Milan,</mods:affiliation></affiliation></author><author><name sortKey="Forastiere, Francesco" sort="Forastiere, Francesco" uniqKey="Forastiere F" first="Francesco" last="Forastiere">Francesco Forastiere</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Onorati, Roberta" sort="Onorati, Roberta" uniqKey="Onorati R" first="Roberta" last="Onorati">Roberta Onorati</name><affiliation><mods:affiliation>Epidemiology Unit, Piedmont Region, Turin, and</mods:affiliation></affiliation></author><author><name sortKey="Pacelli, Barbara" sort="Pacelli, Barbara" uniqKey="Pacelli B" first="Barbara" last="Pacelli">Barbara Pacelli</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Pandolfi, Paolo" sort="Pandolfi, Paolo" uniqKey="Pandolfi P" first="Paolo" last="Pandolfi">Paolo Pandolfi</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Russo, Antonio" sort="Russo, Antonio" uniqKey="Russo A" first="Antonio" last="Russo">Antonio Russo</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Milan,</mods:affiliation></affiliation></author><author><name sortKey="Spadea, Teresa" sort="Spadea, Teresa" uniqKey="Spadea T" first="Teresa" last="Spadea">Teresa Spadea</name><affiliation><mods:affiliation>Epidemiology Unit, Piedmont Region, Turin, and</mods:affiliation></affiliation></author><author><name sortKey="Perucci, Carlo A" sort="Perucci, Carlo A" uniqKey="Perucci C" first="Carlo A." last="Perucci">Carlo A. Perucci</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F5D52CE98C40E25304889FF78B51F0839D4380FA</idno><date when="2006" year="2006">2006</date><idno type="doi">10.1093/intqhc/mzl065</idno><idno type="url">https://api.istex.fr/document/F5D52CE98C40E25304889FF78B51F0839D4380FA/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000A43</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title><author><name sortKey="Agabiti, Nera" sort="Agabiti, Nera" uniqKey="Agabiti N" first="Nera" last="Agabiti">Nera Agabiti</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Picciotto, Sally" sort="Picciotto, Sally" uniqKey="Picciotto S" first="Sally" last="Picciotto">Sally Picciotto</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Cesaroni, Giulia" sort="Cesaroni, Giulia" uniqKey="Cesaroni G" first="Giulia" last="Cesaroni">Giulia Cesaroni</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Bisanti, Luigi" sort="Bisanti, Luigi" uniqKey="Bisanti L" first="Luigi" last="Bisanti">Luigi Bisanti</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Milan,</mods:affiliation></affiliation></author><author><name sortKey="Forastiere, Francesco" sort="Forastiere, Francesco" uniqKey="Forastiere F" first="Francesco" last="Forastiere">Francesco Forastiere</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Onorati, Roberta" sort="Onorati, Roberta" uniqKey="Onorati R" first="Roberta" last="Onorati">Roberta Onorati</name><affiliation><mods:affiliation>Epidemiology Unit, Piedmont Region, Turin, and</mods:affiliation></affiliation></author><author><name sortKey="Pacelli, Barbara" sort="Pacelli, Barbara" uniqKey="Pacelli B" first="Barbara" last="Pacelli">Barbara Pacelli</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Pandolfi, Paolo" sort="Pandolfi, Paolo" uniqKey="Pandolfi P" first="Paolo" last="Pandolfi">Paolo Pandolfi</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author><author><name sortKey="Russo, Antonio" sort="Russo, Antonio" uniqKey="Russo A" first="Antonio" last="Russo">Antonio Russo</name><affiliation><mods:affiliation>Epidemiology Unit, Local Health Authority, Milan,</mods:affiliation></affiliation></author><author><name sortKey="Spadea, Teresa" sort="Spadea, Teresa" uniqKey="Spadea T" first="Teresa" last="Spadea">Teresa Spadea</name><affiliation><mods:affiliation>Epidemiology Unit, Piedmont Region, Turin, and</mods:affiliation></affiliation></author><author><name sortKey="Perucci, Carlo A" sort="Perucci, Carlo A" uniqKey="Perucci C" first="Carlo A." last="Perucci">Carlo A. Perucci</name><affiliation><mods:affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">International Journal for Quality in Health Care</title><title level="j" type="abbrev">Int J Qual Health Care</title><idno type="ISSN">1353-4505</idno><idno type="eISSN">1464-3677</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2007-02">2007-02</date><biblScope unit="volume">19</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="37">37</biblScope><biblScope unit="page" to="44">44</biblScope></imprint><idno type="ISSN">1353-4505</idno></series><idno type="istex">F5D52CE98C40E25304889FF78B51F0839D4380FA</idno><idno type="DOI">10.1093/intqhc/mzl065</idno><idno type="local">065</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1353-4505</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>access to health services</term><term>administrative data</term><term>adverse events</term><term>complications</term><term>hip replacement</term><term>inequalities in health</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective. In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. Design. Multicity population-based longitudinal study. Settings and participants. From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997–2000. Main outcome measures. An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. Results. Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81–0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66–0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. Conclusions. Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Nera Agabiti</name><affiliations><json:string>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item><json:item><name>Sally Picciotto</name><affiliations><json:string>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item><json:item><name>Giulia Cesaroni</name><affiliations><json:string>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item><json:item><name>Luigi Bisanti</name><affiliations><json:string>Epidemiology Unit, Local Health Authority, Milan,</json:string></affiliations></json:item><json:item><name>Francesco Forastiere</name><affiliations><json:string>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item><json:item><name>Roberta Onorati</name><affiliations><json:string>Epidemiology Unit, Piedmont Region, Turin, and</json:string></affiliations></json:item><json:item><name>Barbara Pacelli</name><affiliations><json:string>Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item><json:item><name>Paolo Pandolfi</name><affiliations><json:string>Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item><json:item><name>Antonio Russo</name><affiliations><json:string>Epidemiology Unit, Local Health Authority, Milan,</json:string></affiliations></json:item><json:item><name>Teresa Spadea</name><affiliations><json:string>Epidemiology Unit, Piedmont Region, Turin, and</json:string></affiliations></json:item><json:item><name>Carlo A. Perucci</name><affiliations><json:string>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>access to health services</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>administrative data</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>adverse events</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>complications</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>inequalities in health</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>hip replacement</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective. In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. Design. Multicity population-based longitudinal study. Settings and participants. From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997–2000. Main outcome measures. An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. Results. Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81–0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66–0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. Conclusions. Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.</abstract><qualityIndicators><score>7.409</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 791 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>6</keywordCount><abstractCharCount>1948</abstractCharCount><pdfWordCount>4409</pdfWordCount><pdfCharCount>31642</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>289</abstractWordCount></qualityIndicators><title>The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title><genre><json:string>research-article</json:string></genre><host><volume>19</volume><publisherId><json:string>intqhc</json:string></publisherId><pages><last>44</last><first>37</first></pages><issn><json:string>1353-4505</json:string></issn><issue>1</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1464-3677</json:string></eissn><title>International Journal for Quality in Health Care</title></host><categories><wos><json:string>HEALTH POLICY & SERVICES</json:string><json:string>HEALTH CARE SCIENCES & SERVICES</json:string></wos></categories><publicationDate>2007</publicationDate><copyrightDate>2006</copyrightDate><doi><json:string>10.1093/intqhc/mzl065</json:string></doi><id>F5D52CE98C40E25304889FF78B51F0839D4380FA</id><score>0.2650633</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/F5D52CE98C40E25304889FF78B51F0839D4380FA/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/F5D52CE98C40E25304889FF78B51F0839D4380FA/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/F5D52CE98C40E25304889FF78B51F0839D4380FA/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>International Journal for Quality in Health Care vol. 19 no. 1 © The Author 2006. Published by Oxford University Press on behalf of the International Society for Quality in Health Care (ISQua). All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</p></availability><date>2006-12-11</date></publicationStmt><notesStmt><note>Address reprint requests to Nera Agabiti, Epidemiology Department, Local Health Authority RM/E, Via di S.Costanza 53, 00198 Rome, Italy. E-mail: agabiti@asplazio.it</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title><author xml:id="author-1"><persName><forename type="first">Nera</forename><surname>Agabiti</surname></persName><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation></author><author xml:id="author-2"><persName><forename type="first">Sally</forename><surname>Picciotto</surname></persName><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation></author><author xml:id="author-3"><persName><forename type="first">Giulia</forename><surname>Cesaroni</surname></persName><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation></author><author xml:id="author-4"><persName><forename type="first">Luigi</forename><surname>Bisanti</surname></persName><affiliation>Epidemiology Unit, Local Health Authority, Milan,</affiliation></author><author xml:id="author-5"><persName><forename type="first">Francesco</forename><surname>Forastiere</surname></persName><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation></author><author xml:id="author-6"><persName><forename type="first">Roberta</forename><surname>Onorati</surname></persName><affiliation>Epidemiology Unit, Piedmont Region, Turin, and</affiliation></author><author xml:id="author-7"><persName><forename type="first">Barbara</forename><surname>Pacelli</surname></persName><affiliation>Epidemiology Unit, Local Health Authority, Bologna</affiliation></author><author xml:id="author-8"><persName><forename type="first">Paolo</forename><surname>Pandolfi</surname></persName><affiliation>Epidemiology Unit, Local Health Authority, Bologna</affiliation></author><author xml:id="author-9"><persName><forename type="first">Antonio</forename><surname>Russo</surname></persName><affiliation>Epidemiology Unit, Local Health Authority, Milan,</affiliation></author><author xml:id="author-10"><persName><forename type="first">Teresa</forename><surname>Spadea</surname></persName><affiliation>Epidemiology Unit, Piedmont Region, Turin, and</affiliation></author><author xml:id="author-11"><persName><forename type="first">Carlo A.</forename><surname>Perucci</surname></persName><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation></author></analytic><monogr><title level="j">International Journal for Quality in Health Care</title><title level="j" type="abbrev">Int J Qual Health Care</title><idno type="pISSN">1353-4505</idno><idno type="eISSN">1464-3677</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2007-02"></date><biblScope unit="volume">19</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="37">37</biblScope><biblScope unit="page" to="44">44</biblScope></imprint></monogr><idno type="istex">F5D52CE98C40E25304889FF78B51F0839D4380FA</idno><idno type="DOI">10.1093/intqhc/mzl065</idno><idno type="local">065</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2006-12-11</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objective. In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. Design. Multicity population-based longitudinal study. Settings and participants. From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997–2000. Main outcome measures. An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. Results. Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81–0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66–0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. Conclusions. Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>access to health services</term></item><item><term>administrative data</term></item><item><term>adverse events</term></item><item><term>complications</term></item><item><term>inequalities in health</term></item><item><term>hip replacement</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2006-12-11">Created</change><change when="2007-02">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/F5D52CE98C40E25304889FF78B51F0839D4380FA/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="publisher-id">intqhc</journal-id><journal-id journal-id-type="hwp">intqhc</journal-id><journal-title>International Journal for Quality in Health Care</journal-title><abbrev-journal-title abbrev-type="publisher">Int J Qual Health Care</abbrev-journal-title><issn pub-type="ppub">1353-4505</issn><issn pub-type="epub">1464-3677</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">065</article-id><article-id pub-id-type="doi">10.1093/intqhc/mzl065</article-id><article-categories><subj-group subj-group-type="heading"><subject>Papers</subject></subj-group></article-categories><title-group><article-title>The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Agabiti</surname><given-names>Nera</given-names></name><xref rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Picciotto</surname><given-names>Sally</given-names></name><xref rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cesaroni</surname><given-names>Giulia</given-names></name><xref rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bisanti</surname><given-names>Luigi</given-names></name><xref rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Forastiere</surname><given-names>Francesco</given-names></name><xref rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Onorati</surname><given-names>Roberta</given-names></name><xref rid="AFF3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pacelli</surname><given-names>Barbara</given-names></name><xref rid="AFF4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pandolfi</surname><given-names>Paolo</given-names></name><xref rid="AFF4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Russo</surname><given-names>Antonio</given-names></name><xref rid="AFF2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Spadea</surname><given-names>Teresa</given-names></name><xref rid="AFF3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Perucci</surname><given-names>Carlo A.</given-names></name><xref rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="group-author"><on-behalf-of>on behalf of the <italic>Italian Study Group on Inequalities in Health Care</italic></on-behalf-of><xref rid="FN1">*</xref></contrib><aff id="AFF1"><label>1</label>Epidemiology Department, Local Health Authority RM/E, Rome, <target target-type="aff" id="AFF2"></target><label>2</label>Epidemiology Unit, Local Health Authority, Milan, <target target-type="aff" id="AFF3"></target><label>3</label>Epidemiology Unit, Piedmont Region, Turin, and <target target-type="aff" id="AFF4"></target><label>4</label>Epidemiology Unit, Local Health Authority, Bologna</aff></contrib-group><author-notes><corresp>Address reprint requests to Nera Agabiti, Epidemiology Department, Local Health Authority RM/E, Via di S.Costanza 53, 00198 Rome, Italy. E-mail: <ext-link xlink:href="agabiti@asplazio.it" ext-link-type="email">agabiti@asplazio.it</ext-link></corresp></author-notes><pub-date pub-type="epub"><day>11</day><month>12</month><year>2006</year></pub-date><pub-date pub-type="ppub"><month>February</month><year>2007</year></pub-date><volume>19</volume><issue>1</issue><fpage>37</fpage><lpage>44</lpage><history><date date-type="accepted"><day>15</day><month>11</month><year>2006</year></date></history><permissions><copyright-statement>International Journal for Quality in Health Care vol. 19 no. 1 © The Author 2006. Published by Oxford University Press on behalf of the International Society for Quality in Health Care (ISQua). All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2007</copyright-year><license license-type="open-access"><p></p></license></permissions><abstract xml:lang="en"><p><bold>Objective.</bold> In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes.</p><p><bold>Design.</bold> Multicity population-based longitudinal study.</p><p><bold>Settings and participants.</bold> From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997–2000.</p><p><bold>Main outcome measures.</bold> An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions.</p><p><bold>Results.</bold> Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81–0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66–0.86). Low income was associated with higher risk of acute adverse medical events (<italic>P</italic> trend = 0.05) and of general infections and decubitus ulcer (<italic>P</italic> trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality.</p><p><bold>Conclusions.</bold> Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>access to health services</kwd><kwd>administrative data</kwd><kwd>adverse events</kwd><kwd>complications</kwd><kwd>inequalities in health</kwd><kwd>hip replacement</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>37</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>February 2007</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Paper</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study</title></titleInfo><name type="personal"><namePart type="given">Nera</namePart><namePart type="family">Agabiti</namePart><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sally</namePart><namePart type="family">Picciotto</namePart><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Giulia</namePart><namePart type="family">Cesaroni</namePart><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Luigi</namePart><namePart type="family">Bisanti</namePart><affiliation>Epidemiology Unit, Local Health Authority, Milan,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesco</namePart><namePart type="family">Forastiere</namePart><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roberta</namePart><namePart type="family">Onorati</namePart><affiliation>Epidemiology Unit, Piedmont Region, Turin, and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Barbara</namePart><namePart type="family">Pacelli</namePart><affiliation>Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paolo</namePart><namePart type="family">Pandolfi</namePart><affiliation>Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Antonio</namePart><namePart type="family">Russo</namePart><affiliation>Epidemiology Unit, Local Health Authority, Milan,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Teresa</namePart><namePart type="family">Spadea</namePart><affiliation>Epidemiology Unit, Piedmont Region, Turin, and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carlo A.</namePart><namePart type="family">Perucci</namePart><affiliation>Epidemiology Department, Local Health Authority RM/E, Rome, Epidemiology Unit, Local Health Authority, Milan, Epidemiology Unit, Piedmont Region, Turin, and Epidemiology Unit, Local Health Authority, Bologna</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2007-02</dateIssued><dateCreated encoding="w3cdtf">2006-12-11</dateCreated><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Objective. In countries with universal health coverage, socioeconomic status is not expected to influence access to effective treatment and its prognosis. We tested whether socioeconomic status affects the rates of elective total hip replacement and whether it plays a role in early and late outcomes. Design. Multicity population-based longitudinal study. Settings and participants. From Hospital Registries of four Italian cities (Rome, Milan, Turin, and Bologna), we identified 6140 residents aged 65+ years undergoing elective total hip replacement in 1997–2000. Main outcome measures. An area-based (census block) income index was used for each individual. Poisson regression yielded rate ratios (RR) of population occurrence by income level. Logistic regression estimated odds ratios (OR) of selected outcomes within 90 days. Cox proportional hazard models evaluated effects of income on rates of revision of total hip replacement and mortality up to 31 December 2004. Analyses were adjusted for age, gender, city of residence, and coexisting medical conditions. Results. Low-income people were less likely than high-income counterparts to undergo total hip replacement [RR = 0.87, 95% confidence interval (CI) 0.81–0.95]; the effect was stronger among those aged 75+ years (RR = 0.76, 95% CI = 0.66–0.86). Low income was associated with higher risk of acute adverse medical events (P trend = 0.05) and of general infections and decubitus ulcer (P trend = 0.02) within 90 days. The effects were even higher among those aged 75+ years. No effects were found either for orthopaedic complications within 90 days or for revision and mortality. Conclusions. Total hip replacement is underutilized among elderly deprived individuals. Disadvantaged patients seem more vulnerable to acute adverse medical events after surgery. The evidence of unmet need and poor prognosis of low social class people has important implications for health care policy.</abstract><note type="author-notes">Address reprint requests to Nera Agabiti, Epidemiology Department, Local Health Authority RM/E, Via di S.Costanza 53, 00198 Rome, Italy. E-mail: agabiti@asplazio.it</note><subject lang="en"><genre>KWD</genre><topic>access to health services</topic><topic>administrative data</topic><topic>adverse events</topic><topic>complications</topic><topic>inequalities in health</topic><topic>hip replacement</topic></subject><relatedItem type="host"><titleInfo><title>International Journal for Quality in Health Care</title></titleInfo><titleInfo type="abbreviated"><title>Int J Qual Health Care</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1353-4505</identifier><identifier type="eISSN">1464-3677</identifier><identifier type="PublisherID">intqhc</identifier><identifier type="PublisherID-hwp">intqhc</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>19</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>37</start><end>44</end></extent></part></relatedItem><identifier type="istex">F5D52CE98C40E25304889FF78B51F0839D4380FA</identifier><identifier type="DOI">10.1093/intqhc/mzl065</identifier><identifier type="local">065</identifier><accessCondition type="use and reproduction" contentType="copyright">International Journal for Quality in Health Care vol. 19 no. 1 © The Author 2006. Published by Oxford University Press on behalf of the International Society for Quality in Health Care (ISQua). All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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