Medicare Beneficiaries in Rural Areas More Likely to
Choose Joint Replacement Surgery
Women more likely to have total joint replacement
but since arthritis more common in women, men may have higher percentage
Nov. 30, 2009 - Medicare beneficiaries living in
rural areas were 27% more likely than urban recipients to have total
knee or hip replacement surgeries. Southern Illinois University
researchers also found women were more likely than men to undergo total
joint replacement surgeries.
Differences in elective joint surgeries between
white individuals and minorities in both rural and urban areas were
observed, but were less pronounced in rural settings. Full findings
appear in the in the December issue of Arthritis & Rheumatism, a
journal published by Wiley-Blackwell on behalf of the American College
of Rheumatology.
Arthritis is the leading cause of disability in the
U.S., and musculoskeletal problems consume roughly 2.5% of U.S. gross
domestic product.
The National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) reported that 773,000
Americans have a hip or knee replaced each year. Generally, new joints
last 10 to 15 years and younger patients may need to have repeated
surgeries to replace damaged joints.
The research team, led by Mark L. Francis, M.D.,
used the 2005 Medicare Provider Analysis and Review File from the
Centers for Medicare and Medicaid Services along with the entire 2005
Medicare denominator file to establish the study group.
This cohort was comprised of close to 6 million
rural Medicare beneficiaries and nearly 38 million urban recipients.
Both men and women were represented in the study,
with a mean age of 70 for rural and 71 for urban participants. Racial
representation in the rural versus urban areas included white (90.8% vs.
83.2%), African American (6.4% vs. 10.5%), Hispanic (0.6% vs. 2.3%),
Asian (0.2% vs. 1.9%), Native American (1.3% vs. 0.3%), and other (0.5%
vs. 1.7%).
Of the number of participants in the study, 1.02%
of rural and 0.80% of urban beneficiaries underwent a total knee or hip
replacement surgery in 2005. Results showed 27% more rural beneficiaries
were likely to have total knee or hip replacement surgeries than
Medicare recipients in urban areas.
"We were surprised by the finding that more rural
participants elected to undergo joint surgery than those in urban
areas," said Dr. Francis. "There was reason to believe that differences
in physician access, cultural backgrounds, and the need to travel
farther for surgery would deter more rural patients from elective
surgical procedures."
In addition to confirming earlier findings with
African Americans and Hispanics, this study also finds similar
disparities for Asians and Native Americans. Although there were some
differences among minority groups compared to Caucasians, these
disparities were overall less in rural areas.
The current study concurred with prior study
results finding that women were more likely to have total joint
replacement surgeries compared with men.
However, given the higher prevalence of arthritis
in women it is likely that men with arthritis had total joint
replacement surgeries relatively more frequently than women noted the
authors. According to a 2006 report from the Centers for Disease Control
and Prevention (CDC), the prevalence of arthritis in women was 25.4%
compared with 17.6% in men.
"While our study explored differences between rural
and urban areas, joint replacement surgeries in suburban populations is
an important area for future research," concluded Dr. Francis. The
authors also emphasized that results from this study are based on an
industrialized country with an advanced transportation infrastructure
and should not be generalized to less industrialized countries.
Keep up with the latest news for senior citizens, baby
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Nov. 30, 2009 - Medicare beneficiaries living in
rural areas were 27% more likely than urban recipients to have total
knee or hip replacement surgeries. Southern Illinois University
researchers also found women were more likely than men to undergo total
joint replacement surgeries. 