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Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas.
Arthritis Rheum. 2009 Dec; 60(12):3554-62.AR

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries.

Authors+Show Affiliations

Southern Illinois University School of Medicine, Springfield, IL 62794-9636, USA. mfrancis@siumed.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19950278

Citation

Francis, Mark L., et al. "Joint Replacement Surgeries Among Medicare Beneficiaries in Rural Compared With Urban Areas." Arthritis and Rheumatism, vol. 60, no. 12, 2009, pp. 3554-62.
Francis ML, Scaife SL, Zahnd WE, et al. Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas. Arthritis Rheum. 2009;60(12):3554-62.
Francis, M. L., Scaife, S. L., Zahnd, W. E., Cook, E. F., & Schneeweiss, S. (2009). Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas. Arthritis and Rheumatism, 60(12), 3554-62. https://doi.org/10.1002/art.25004
Francis ML, et al. Joint Replacement Surgeries Among Medicare Beneficiaries in Rural Compared With Urban Areas. Arthritis Rheum. 2009;60(12):3554-62. PubMed PMID: 19950278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Joint replacement surgeries among medicare beneficiaries in rural compared with urban areas. AU - Francis,Mark L, AU - Scaife,Steven L, AU - Zahnd,Whitney E, AU - Cook,E Francis, AU - Schneeweiss,Sebastian, PY - 2009/12/2/entrez PY - 2009/12/2/pubmed PY - 2010/2/19/medline SP - 3554 EP - 62 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 60 IS - 12 N2 - OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/19950278/Joint_replacement_surgeries_among_medicare_beneficiaries_in_rural_compared_with_urban_areas_ L2 - https://doi.org/10.1002/art.25004 DB - PRIME DP - Unbound Medicine ER -