Fairness in access to healthcare is one of the founding principles of the NHS, yet there is some evidence that those with the greatest need are often the least likely to access care. Here we look at the relationship between the rate of NHS hip replacement operations, as a proxy for access to elective care, and deprivation in England.
The chart shows the directly standardised rate of hip replacement operations per 100,000 population, adjusted for sex and age, by index of multiple deprivation (IMD) decile in 2017/18. The most deprived decile had the lowest surgery rate, with 164 hip replacements per 100,000 population. The highest surgery rate was found in decile eight, with 221 hip replacements per 100,000 population. Research has shown that there is a higher prevalence of joint problems in more deprived areas, for example higher rates of GP consultation for osteoarthritis (the most common reason for needing a hip replacement). The lower rates of procedures in the more deprived areas could represent some unmet need (and be an example of the ‘inverse care law’).
Between 2008/09 and 2017/18, the rates of hip replacement operation decreased in the most deprived areas, but increased in the least deprived areas. Rates of hip replacement decreased by 4.2 per 100,000 population in the most deprived decile, but increased by 15.3 per 100,000 population in the least deprived decile. The largest increase of 19.5 per 100,000 population was found in decile eight.
The ratio of inequality (rate in most deprived decile ÷ rate in lease deprived decile) decreased from 0.85 in 2008/09 to 0.77 in 2017/18, indicating that inequality of access for hip replacements has got worse (data not shown).
About this data
These indicators use data from Hospital Episode Statistics (HES) and the Office for National Statistics (ONS).
Definition: Directly standardised rate of NHS hip replacement operations per 100,000 population aged 18+ years.
Numerator: Number of hip replacement operations of adults aged 18+ years where the main operation code is between W37-W39 or W93-W95.
Denominator: Mid-year population estimates by age and sex at Lower Layer Super Output Area (LSOA) in England.