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 2018/19. The most deprived decile had the lowest surgery rate, with 176 hip replacements per 100,000 population. The highest surgery rate was found in decile seven, with 229 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 an example of the ‘inverse care law’).
Between 2008/09 and 2018/19, the rates of hip replacement operations increased in both the most and least deprived areas, but the increase was smaller in the most deprived areas. Rates of hip replacement increased by 6 per 100,000 population in the most deprived decile, but increased by 19.7 per 100,000 population in the least deprived decile. The largest increase of 22.5 per 100,000 population was found in decile eight.
The ratio of inequality (rate in most deprived decile ÷ rate in least deprived decile) decreased from 0.85 in 2008/09 to 0.8 in 2018/19, 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.