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. 2022 Jul 9;22(1):891.
doi: 10.1186/s12913-022-08305-7.

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

Kristiina Manderbacka  1 , Markku Satokangas  2   3 , Martti Arffman  2 , Eeva Reissell  2 , Ilmo Keskimäki  2   4 , Alastair H Leyland  5
Affiliations

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

Kristiina Manderbacka et al. BMC Health Serv Res. .

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.

Keywords: Equity in health care; Health services research; Joint arthroplasty; Medical practice variation; Register-based study.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Annual rates (/100 000 person years) of elective total hip (THA) and knee (TKA) arthroplasties by hospital district in Finland between 2010 − 2017
Fig. 2
Fig. 2
Hospital district variation of elective total hip (THA) and knee (TKA) arthroplasties controlling for age and gender only (Null model) in 2010 − 2013 and 2014 − 2017. Striped areas have incidence rate rations (IRR) over the country average
See this image and copyright information in PMC

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