Barriers to Hip and Knee Replacement: An Empirical Analysis

In this study, we examined variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics.  We analyzed data from the U.S. Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+).  We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR.

Our results demonstrate that being married/partnered with a healthy spouse/partner is positively associated with JR utilization among men in both age groups (65+ group OR: 1.322 and <65 group OR: 1.476) while it has no statistically significant effect on JR use among women.  Among women younger than 65, having children younger than 18 years old lowers the odds (OR: 0.201) and caring for grandchildren increases the odds (1.364) of having a JR.  Finally,  elderly women who report availability of household assistance from a child have higher odds of receiving a JR as compared with elderly women without a child who could assist (OR: 1.281).  No effect of available support from children was observed for those under 65 years old and elderly men.

Our results show that intra-family dynamics and familial support are important determinants of JR; however, their effects vary by gender and age.  Establishing appropriate support mechanisms could increase access to cost-effective JR among patients in need of surgery.

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