{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:55:48Z","timestamp":1791572148701,"version":"4.3.4"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024396","name":"Healthcare Quality Improvement Partnership","doi-asserted-by":"publisher","award":["HQIP-FTS 010307-2022"],"award-info":[{"award-number":["HQIP-FTS 010307-2022"]}],"id":[{"id":"10.13039\/501100024396","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR ARC West"],"award-info":[{"award-number":["NIHR ARC West"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015250","name":"NIHR Bristol Biomedical Research Centre","doi-asserted-by":"publisher","award":["IS-BRC-1215-20011"],"award-info":[{"award-number":["IS-BRC-1215-20011"]}],"id":[{"id":"10.13039\/100015250","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reducing health inequalities is of national importance. Total hip replacement (THR) is a commonly used elective surgical procedure. Few studies have examined area-level inequalities for a wide range of outcomes following THR. The aim of this study is to compare area-level socioeconomic differences in outcomes following primary THR surgery for osteoarthritis in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>This is a population-based prospective cohort study of the National Joint Registry (NJR). Data from the NJR were linked to national mortality, Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases for England from 2007 to 2017 with follow-up to 2023 for outcomes, for patients aged 50 years and over with osteoarthritis. Outcomes of 90-day mortality; 5-year revision rate; 6-month health complications; 1-year rehospitalisation and reoperation for orthopaedic indications; and patient-reported Oxford Hip Score (OHS), post-THR surgery were examined by area-level Index of Multiple Deprivation quintiles. Modified Poisson regression was adjusted for patient age, sex, body mass index, pre-operative physical state and comorbidity.<\/jats:p>\n                    <jats:p>\n                      Among 448,184 patients with primary THR, mean age was 70 years (standard deviation: 9 years) and 61% were women. Patients from the most deprived group were more likely to die within 90 days of the operation compared to the least deprived group (adjusted rate ratio, RR: 1.25 (95% confidence interval (CI) [1.07, 1.46]); adjusted risk difference, RD: 9 (95% CI [2, 16]) per 10,000. Similarly, those from the most deprived group were more likely to experience complications (RR: 1.26 (95% CI [1.21, 1.32]); RD: 1.14% (95% CI [0.92, 1.36])); be rehospitalised (RR: 1.16 (95% CI [1.14, 1.19]; RD: 2.78% (95% CI [2.39, 3.17])) or reoperated (RR: 1.23 (95% CI [1.13, 1.33]); RD: 0.31% (95% CI [0.19, 0.44])) and report poorer OHS (adjusted score: \u22122.97 (95% CI [\u22123.10, \u22122.84])\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009200,522). There was no variation by deprivation level for THR revision rates at 5 years (RR: 1.02 (95% CI [0.94, 1.10]); RD: 0.02% (95% CI [\u22120.10, 0.15])). The main study limitations are the lack of complete PROMs data, and the exclusion of self-funded patients or those with private insurance for THR procedures in independent hospitals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inequalities in several outcomes after THR are present in England by area-level deprivation. These findings are useful to inform shared decision-making for patients deciding whether to undergo hip replacement and to benchmark the effectiveness of policies which aim to reduce health inequalities following THR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004870","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:49:27Z","timestamp":1770058167000},"page":"e1004870","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Social inequalities in patient outcomes after total hip replacement surgery for osteoarthritis in England: A population-based cohort study of the National Joint Registry"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9136-9529","authenticated-orcid":true,"given":"Rita","family":"Patel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0371-731X","authenticated-orcid":true,"given":"Erik","family":"Lenguerrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6648-3007","authenticated-orcid":true,"given":"Yoav","family":"Ben-Shlomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9677-4657","authenticated-orcid":true,"given":"Jonathan","family":"French","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Rangan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4847-1157","authenticated-orcid":true,"given":"Robin","family":"Brittain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Deere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7452-5043","authenticated-orcid":true,"given":"Adrian","family":"Sayers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley W.","family":"Blom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Whitehouse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3015-0432","authenticated-orcid":true,"given":"Andrew","family":"Judge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"pmed.1004870.ref001","unstructured":"https:\/\/www.longtermplan.nhs.uk\/ [cited 04 June 2025]."},{"key":"pmed.1004870.ref002","article-title":"Strategic review of health inequalities in England post-2010","author":"M Marmot","year":"2010","journal-title":"University College London"},{"key":"pmed.1004870.ref003","article-title":"Health equity in England: the Marmot review 10 years on","volume":"368","author":"M Marmot","year":"2020","journal-title":"BMJ"},{"key":"pmed.1004870.ref004","unstructured":"https:\/\/www.england.nhs.uk\/about\/equality\/equality-hub\/national-healthcare-inequalities-improvement-programme\/ [cited 04 June 2025]."},{"key":"pmed.1004870.ref005","unstructured":"https:\/\/www.instituteofhealthequity.org\/resources-reports\/build-back-fairer-the-covid-19-marmot-review\/build-back-fairer-the-covid-19-marmot-review-full-report.pdf [cited 04 June 2025]."},{"key":"pmed.1004870.ref006","article-title":"The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study","author":"A Judge","year":"2020","journal-title":"Southampton (UK): NIHR Journals Library"},{"issue":"4","key":"pmed.1004870.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004210","article-title":"Inequalities in provision of hip and knee replacement surgery for osteoarthritis by age, sex, and social deprivation in England between 2007-2017: a population-based cohort study of the National Joint Registry","volume":"20","author":"E Lenguerrand","year":"2023","journal-title":"PLoS Med"},{"issue":"2","key":"pmed.1004870.ref008","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/CORR.0000000000002394","article-title":"Is social deprivation associated with usage, adverse events, and patient-reported outcome measures in total joint arthroplasty? A systematic review","volume":"481","author":"A Karimi","year":"2023","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"pmed.1004870.ref009","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1302\/0301-620X.93B4.25717","article-title":"Socioeconomic status affects the early outcome of total hip replacement","volume":"93","author":"ND Clement","year":"2011","journal-title":"J Bone Joint Surg Br"},{"issue":"6","key":"pmed.1004870.ref010","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/SLA.0000000000004691","article-title":"County-level social vulnerability is associated with worse surgical outcomes especially among minority patients","volume":"274","author":"A Diaz","year":"2021","journal-title":"Ann Surg"},{"issue":"1","key":"pmed.1004870.ref011","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/intqhc\/mzl065","article-title":"The influence of socioeconomic status on utilization and outcomes of elective total hip replacement: a multicity population-based longitudinal study","volume":"19","author":"N Agabiti","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"6","key":"pmed.1004870.ref012","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S1479-666X(09)80109-1","article-title":"Deprivation influences the functional outcome from total hip arthroplasty","volume":"7","author":"PJ Jenkins","year":"2009","journal-title":"Surgeon"},{"issue":"3","key":"pmed.1004870.ref013","article-title":"UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study","volume":"12","author":"LK Smith","year":"2022","journal-title":"BMJ Open"},{"issue":"2","key":"pmed.1004870.ref014","article-title":"The utility of the area deprivation index in assessing complications after total joint arthroplasty","volume":"9","author":"JA Dubin","year":"2024","journal-title":"JB JS Open Access"},{"issue":"2","key":"pmed.1004870.ref015","doi-asserted-by":"crossref","DOI":"10.1016\/S2665-9913(19)30045-1","article-title":"Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements","volume":"1","author":"SK Kunutsor","year":"2019","journal-title":"Lancet Rheumatol"},{"issue":"1","key":"pmed.1004870.ref016","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1093\/pubmed\/fds048","article-title":"Socioeconomic differences in patient-reported outcomes after a hip or knee replacement in the English National Health Service","volume":"35","author":"J Neuburger","year":"2013","journal-title":"J Public Health (Oxf)"},{"key":"pmed.1004870.ref017","unstructured":"https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2015 [cited 04 June 2025]."},{"key":"pmed.1004870.ref018","unstructured":"https:\/\/www.njrcentre.org.uk\/ [cited 04 June 2025]."},{"issue":"11","key":"pmed.1004870.ref019","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1302\/2046-3758.311.2000313","article-title":"Can pain and function be distinguished in the Oxford Hip Score in a meaningful way?\u00a0: An exploratory and confirmatory factor analysis","volume":"3","author":"KK Harris","year":"2014","journal-title":"Bone Joint Res"},{"key":"pmed.1004870.ref020","unstructured":"https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/proms\/ [cited 04 June 2025]."},{"issue":"8","key":"pmed.1004870.ref021","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1302\/0301-620X.89B8.19424","article-title":"The use of the Oxford hip and knee scores","volume":"89","author":"DW Murray","year":"2007","journal-title":"J Bone Joint Surg Br"},{"issue":"9","key":"pmed.1004870.ref022","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1016\/j.arth.2020.04.034","article-title":"Are Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index useful predictors of clinical meaningful improvement and satisfaction after total hip arthroplasty?","volume":"35","author":"MGH Yeo","year":"2020","journal-title":"J Arthroplasty"},{"key":"pmed.1004870.ref023","unstructured":"Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification; 2017."},{"issue":"5","key":"pmed.1004870.ref024","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1002\/bjs.6930","article-title":"Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson Score","volume":"97","author":"Royal College of Surgeons Co-morbidity Consensus Group","year":"2010","journal-title":"Br J Surg"},{"issue":"7","key":"pmed.1004870.ref025","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified poisson regression approach to prospective studies with binary data","volume":"159","author":"G Zou","year":"2004","journal-title":"Am J Epidemiol"},{"issue":"10","key":"pmed.1004870.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"EI Benchimol","year":"2015","journal-title":"PLoS Med"},{"issue":"7168","key":"pmed.1004870.ref027","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1136\/bmj.317.7168.1309","article-title":"Confidence intervals for the number needed to treat","volume":"317","author":"DG Altman","year":"1998","journal-title":"BMJ"},{"issue":"1","key":"pmed.1004870.ref028","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12939-020-01227-y","article-title":"Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank","volume":"19","author":"AP Patel","year":"2020","journal-title":"Int J Equity Health"},{"issue":"3","key":"pmed.1004870.ref029","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1093\/pubmed\/fdr119","article-title":"Sociodemographic differences in the severity and duration of disease amongst patients undergoing hip or knee replacement surgery","volume":"34","author":"J Neuburger","year":"2012","journal-title":"J Public Health (Oxf)"},{"key":"pmed.1004870.ref030","unstructured":"Ben-Shlomo Y, Blom A, Boulton C, Brittain R, Clark E, Dawson-Bowling S. The national joint registry 18th annual report 2021; 2022."},{"issue":"2","key":"pmed.1004870.ref031","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/CORR.0000000000002222","article-title":"Are neighborhood characteristics associated with outcomes after THA and TKA? Findings from a large Healthcare System Database","volume":"481","author":"MA Adelani","year":"2023","journal-title":"Clin Orthop Relat Res"},{"issue":"9898","key":"pmed.1004870.ref032","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/S0140-6736(13)61749-3","article-title":"90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis","volume":"382","author":"LP Hunt","year":"2013","journal-title":"Lancet"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004870","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:49:33Z","timestamp":1770058173000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004870"}},"subtitle":[],"editor":[{"given":"Christelle","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004870","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}