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      Regional variation in hip and knee arthroplasty rates in Switzerland: A population-based small area analysis

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          Abstract

          Background

          Compared to other OECD countries, Switzerland has the highest rates of hip (HA) and knee arthroplasty (KA).

          Objective

          We assessed the regional variation in HA/KA rates and potential determinants of variation in Switzerland.

          Methods

          We conducted a population-based analysis using discharge data from all Swiss hospitals during 2013–2016. We derived hospital service areas (HSAs) by analyzing patient flows. We calculated age-/sex-standardized procedure rates and measures of variation (the extremal quotient [EQ, highest divided by lowest rate] and the systemic component of variation [SCV]). We estimated the reduction in variance of HA/KA rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, sex, language, urbanization, socioeconomic factors, burden of disease, and the number of orthopedic surgeons.

          Results

          Overall, 69,578 HA and 69,899 KA from 55 HSAs were analyzed. The mean age-/sex-standardized HA rate was 265 (range 179–342) and KA rate was 256 (range 186–378) per 100,000 persons and increased over time. The EQ was 1.9 for HA and 2.5 for KA. The SCV was 2.0 for HA and 2.2 for KA, indicating a low variation across HSAs. When adjusted for procedure year and demographic, cultural, and sociodemographic factors, the models explained 75% of the variance in HA and 63% in KA across Swiss HSAs.

          Conclusion

          Switzerland has high HA/KA rates with a modest regional variation, suggesting that the threshold to perform HA/KA may be uniformly low across regions. One third of the variation remained unexplained and may, at least in part, represent differing physician beliefs and attitudes towards joint arthroplasty.

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          Most cited references46

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          Epidemiology of osteoarthritis

          The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors.
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            • Article: not found

            The effects of specific medical conditions on the functional limitations of elders in the Framingham Study.

            The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks; to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity; and to determine the proportion of disability attributable to each condition. The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 +/- 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease, intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology, and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities. Stroke was significantly associated with functional limitations in all seven tasks; depressive symptomatology and hip fracture were associated with limitations in five tasks; and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each. In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases.
              • Record: found
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              Ecological correlations and the behavior of individuals.

                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 September 2020
                2020
                : 15
                : 9
                : e0238287
                Affiliations
                [1 ] Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
                [2 ] Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
                [3 ] CTU Bern, University of Bern, Bern, Switzerland
                [4 ] Queensland Centre for Population Research, School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
                [5 ] Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
                [6 ] Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
                [7 ] Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
                The University of the South Pacific, FIJI
                Author notes

                Competing Interests: The authors declare no additional funding or competing interests such as consultancies, stock ownership or other payments other than the reported funding sources. Dr. Haynes is affiliated with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern is involved in design, conduct, or analysis of clinical studies funded by not-for-profit and for-profit organizations. In particular, pharmaceutical and medical device companies provide direct funding to some of these studies. For an up-to-date list of CTU Bern’s conflicts of interest see http://www.ctu.unibe.ch/research/declaration_of_interest/index_eng.html. This does not alter our adherence to all PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0001-6347-0198
                http://orcid.org/0000-0001-5141-683X
                Article
                PONE-D-19-30889
                10.1371/journal.pone.0238287
                7505431
                32956363
                8bac419b-a4dc-4034-a71c-e77aa42d504e
                © 2020 Wertli et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 November 2019
                : 29 July 2020
                Page count
                Figures: 3, Tables: 3, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001711, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung;
                Award ID: 407440_167339
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100005688, Gottfried und Julia Bangerter-Rhyner-Stiftung;
                Award Recipient :
                Funded by: Swiss Society of General Internal Medicine Foundation
                Award Recipient :
                DA, MMW, AC, RP, CS, and NR were awarded a grant by the National Research Program 74 of the Swiss National Science Foundation (SNSF), Grant number SNSF 407440_167339, the Health Services Research funding program of the Gottfried and Julia Bangerter-Rhyner-Stiftung and the Swiss Society of General Internal Medicine Foundation. The sponsors did not have influence on the study design, the collection, analysis and interpretation of the data, the writing of the report, and in the decision to submit the manuscript for publication.
                Categories
                Research Article
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Musculoskeletal System Procedures
                Orthopedic Surgery
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Musculoskeletal System Procedures
                Arthroplasty
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Physicians
                Surgeons
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Physicians
                Surgeons
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Pelvis
                Hip
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Pelvis
                Hip
                Social Sciences
                Economics
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Economics
                Health Insurance
                People and Places
                Geographical Locations
                Europe
                Switzerland
                Medicine and Health Sciences
                Public and Occupational Health
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Skeletal Joints
                Knees
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Skeleton
                Skeletal Joints
                Knees
                Biology and Life Sciences
                Anatomy
                Body Limbs
                Legs
                Knees
                Medicine and Health Sciences
                Anatomy
                Body Limbs
                Legs
                Knees
                Custom metadata
                A minimal data set necessary to replicate the variation analysis is in the Supporting Information files with the age-/sex-adjusted rates per HSA. Data are also available via the following DOI: ( 10.7892/boris.146180). Due to legal restrictions we are not able to provide a minimal dataset to replicate the regression models. The Swiss Federal Statistical Office (SFSO) data privacy law prohibited the sharing of the data with other researchers. However, a data set including the variables used for the regression models may be requested from the SFSO: Swiss Federal Statistical Office (SFSO) Sektion Gesundheitsversorgung, Espace de l’Europe 10, CH-2010 Neuchaˆtel, Switzerland Phone: +41 58 463 67 00 Email: gesundheit@ 123456bfs.admin.ch .

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