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Previous Volume 342:1016-1022 April 6, 2000 Number 14 Next

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ABSTRACT

Background Previous studies suggest that, for some conditions, women receive fewer health care interventions than men. We estimated the potential need for arthroplasty and the willingness to undergo the procedure in both men and women and examined whether there were differences between the sexes.

Methods All 48,218 persons 55 years of age or older in two areas of Ontario, Canada, were surveyed by mail and telephone to identify those with hip or knee problems. In these subjects, we assessed the severity of arthritis and the presence of coexisting conditions by questionnaire, documented arthritis by examination and radiography, and conducted interviews to evaluate the subjects' willingness to undergo arthroplasty. The potential need for arthroplasty was defined by the presence of severe symptoms and disability, the absence of any absolute contraindications to surgery, and clinical and radiographic evidence of arthritis. The estimates of need were then adjusted for the subjects' willingness to undergo arthroplasty.

Results The overall response rates were at least 72 percent for the questionnaires and interviews. As compared with men, women had a higher prevalence of arthritis of the hip or knee (age-adjusted odds ratio, 1.76; P<0.001) and had worse symptoms and greater disability, but women were less likely to have undergone arthroplasty (adjusted odds ratio, 0.78; P<0.001). Despite their equal willingness to have the surgery, fewer women than men had discussed the possibility of arthroplasty with a physician (adjusted odds ratio, 0.63). The numbers of people with a potential need for hip or knee arthroplasty were 44.9 per 1000 among women and 20.8 per 1000 among men. After adjustment for willingness to undergo the procedure, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men.

Conclusions There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men.

Source Information

From the Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto, and Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Centre (G.A.H.); the Clinical Epidemiology and Health Care Research Program (G.A.H., J.G.W., J.I.W., R.G., E.M.B.); the Department of Surgery, Division of Orthopaedic Surgery, Hospital for Sick Children (J.G.W.); the Department of Family and Community Medicine, University of Toronto (J.I.W.); the Department of Family and Community Medicine, St. Michael's Hospital (R.G.); the Departments of Health Administration (G.A.H., P.C.C.) and Public Health Sciences (J.G.W., J.I.W., B.H., R.G., E.M.B.), University of Toronto; the Arthritis Community Research and Evaluation Unit, Wellesley Hospital Research Institute (G.A.H., P.C.C., R.G., E.M.B.); and the Institute for Clinical Evaluative Sciences (P.C.C., J.I.W.) — all in Toronto.

Address reprint requests to Dr. Hawker at Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville St., 10th Fl., Toronto, ON M5S 1B2, Canada, or at g.hawker{at}utoronto.ca.

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