1
Supplementary Materials
This appendix has been provided by the authors to give readers additional information
about his work.
Supplement to: Cookson RA, Gutacker N, Garcia-Armesto S, Angulo-Pueyo E,
Christiansen E, Bloor K, Bernal-Delgado E. Socioeconomic inequality in hip
replacement in four European countries from 2002 to 2009 – area level analysis of
hospital data. Eur J Public Health. 2015;
CONTENT

Appendix Table A. Descriptive statistics about the quintile groups of administrative
areas.

Appendix Table B. ECHO Coding of Hip Replacement.

Appendix C. Larger-scale version of Figure 2 split into three separate graphs.

Figure C1. Trends in socioeconomic inequality 2002-9 – age-sex standardised rate of
hip replacement per 10,000 adults over 35 by quintile group.

Figure C2. Trends in socioeconomic inequality 2002-9 – absolute differences in agesex standardised rate of hip replacement per 10,000 adults over 35 by quintile
group.

Figure C3. Trends in socioeconomic inequality 2002-9 – relative differences in agesex standardised rate of hip replacement per 10,000 adults over 35 by quintile
group.

Appendix D. National level association between hip replacement rate and GDP.

Figure D1. Hip replacement rate versus GPD per capita in 2009 for OECD countries,
with bubble size proportional to population and regression line weighted by
population.

Table D1. OECD data for the year 2009 on hip replacement rate, GPD per capita and
population in OECD countries. Countries are ranked by hip replacement rate.
2
Appendix Table A: Descriptive statistics about the quintile groups of administrative areas
2002
Total
%
Median
population population income* †
N
N
Denmark
Q1
12
592,466
19.8%
34,051 €
12
Q2
16
604,341
20.2%
36,966 €
16
Q3
21
567,917
19.0%
38,408 €
22
Q4
23
629,416
21.0%
40,466 €
22
Q5
26
602,357
20.1%
47,769 €
26
England
Q1
48
5,439,039
19.9%
21.5%
49
Q2
46
5,278,998
19.4%
16.0%
54
Q3
68
5,546,538
20.3%
12.5%
67
Q4
81
5,522,852
20.2%
9.0%
76
Q5
83
5,486,995
20.1%
6.0%
80
Portugal
Q1
100
1,104,406
20.0%
5,183 €
99
Q2
99
1,094,770
19.8%
6,143 €
98
Q3
44
1,112,234
20.1%
7,076 €
44
Q4
22
1,071,450
19.4%
7,907 €
23
Q5
13
1,142,230
20.7%
8,992 €
14
Slovenia
Q1
3
Q2
2
Q3
3
Q4
2
Q5
2
Spain
Q1
51
4,529,079
19.7%
8,800 €
51
Q2
37
4,273,693
18.6%
9,750 €
37
Q3
44
4,927,217
21.5%
11,700 €
44
Q4
44
4,539,788
19.8%
12,400 €
44
Q5
23
4,680,936
20.4%
14,000 €
23
* England: percentage of people receiving benefits; Spain: midpoint of income group
† Based on exchange rate on 01/07/2002 and 01/07/2009
2009
Total
%
Median
population population income* †
613,170
632,740
651,972
620,052
649,607
19.4%
20.0%
20.6%
19.6%
20.5%
33,970 €
36,878 €
38,318 €
40,447 €
47,655 €
5,762,757
5,819,699
5,808,909
5,842,997
5,858,907
19.8%
20.0%
20.0%
20.1%
20.1%
24.0%
17.0%
14.0%
10.0%
8.0%
1,185,949
1,186,673
1,228,696
1,164,530
1,242,934
19.7%
19.7%
20.4%
19.4%
20.7%
6,351 €
7,406 €
8,273 €
9,332 €
10,418 €
415,904
346,782
150,043
183,049
103,362
34.7%
28.9%
12.5%
15.3%
8.6%
9,701 €
10,003 €
10,293 €
10,609 €
11,387 €
5,290,654
5,017,326
5,879,871
5,345,286
5,457,656
19.6%
18.6%
21.8%
19.8%
20.2%
8,800 €
9,750 €
11,700 €
12,400 €
14,000 €
The average income of the quintile group is based on area level data on mean income for Denmark, Portugal,
Slovenia and Spain and mean deprivation score for England. In each case we compute the quintile group
average as the median value among all the areas within the group. We cannot compute the quintile group
level mean because for Spain we only have data on interval bands for area level mean income and the first and
last intervals have no lower and upper bound, respectively.
3
Appendix Table B: ECHO Coding of Hip Replacement
DEFINITION
Discharges, aged 35 years and older, with any procedure code for primary hip replacement excluding
diagnoses of fractures and accidents.
Numerator type: Discharges, aged 35 years and older, with any procedure code for primary hip
replacement excluding fractures and accidents diagnosis.
Denominator type: Population aged 35 and older.
CODING CROSSWALKS
SPAIN/PORTUGAL
ICD-9-CM Primary Diagnosis
Inclusions Exclusions
733.10, 733.14, 820, 821,
E800-E849.9
ICD-9-CM Secondary Diagnosis
Inclusions Exclusions
E800-E849.9
ICD-9-CM Procedures
Inclusions Exclusions
81.51
81.52
DENMARK
ICD-10 Primary Diagnosis
Inclusions Exclusions
S720
S721
S722
S729
M844
M80
V01-V99
NOMESCO
Procedures
Inclusions Exclusions
NFB
ICD-10 Secondary Diagnosis
Inclusions Exclusions
V01-V99
4
ENGLAND
ICD-10 Primary Diagnosis
Inclusions Exclusions
S720
S721
S722
S729
M844
M80
V01-V99
ICD-10 Secondary Diagnosis
Inclusions Exclusions
V01-V99
OPCS Procedures
Inclusions Exclusions
W371
W378
W379
W381
W388
W389
W391
W398
W399
W461
W468
W469
W471
W478
W479
W481
W482
W488
W489
W931
W941
W948
W949
W951
W958
W959
SLOVENIA
ICD-10 Primary Diagnosis
Inclusions Exclusions
S720
S721
S722
S729
M844
M80
V01-V99
ACHI Procedures
Inclusions Exclusions
4931500
4931800
4931900
ICD-10 Secondary Diagnosis
Inclusions Exclusions
V01-V99
5
Appendix C: Larger scale version of Figure 2 split into three separate graphs
Figures C1, C2 and C3 reproduce the three panels of Figure 2 on a larger scale, enabling readers of a
printed version to discern finer points of detail.
Figure C1. Trends in socioeconomic inequality 2002-9 – age-sex standardised rate of hip
replacement per 10,000 adults over 35 by quintile group
Q1 is the poorest and Q5 the richest administrative area. 95% confidence intervals are not shown, for ease of viewing.
6
Figure C2. Trends in socioeconomic inequality 2002-9 – absolute differences in age-sex
standardised rate of hip replacement per 10,000 adults over 35 by quintile group
Q1 is the poorest and Q5 the richest administrative area. 95% confidence intervals are not shown, for ease of viewing.
7
Figure C3. Trends in socioeconomic inequality 2002-9 – relative differences in age-sex standardised
rate of hip replacement per 10,000 adults over 35 by quintile group
Q1 is the poorest and Q5 the richest administrative area. 95% confidence intervals are not shown, for ease of viewing.
8
Appendix D: National level association between hip replacement rate and GDP
300
400
Figure D1. Hip replacement rate versus GPD per capita in 2009 for OECD countries, with bubble
size proportional to population and regression line weighted by population
Germany
Switzerland
Denmark
France
Norway
200
Luxembourg
United Kingdom
Slovenia
Czech Republic
Italy
Greece
United States
Australia
100
Canada
Hungary
Poland
Israel
Korea
0
Mexico
Portugal Spain
10000
30000
50000
GDP per capita in US dollars PPP
70000
Source: Hip replacement rates for 2009 from OECD Health at a Glance 2011; GDP and population data for 2009 from OECD
Library Stat Extracts:
http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/07/index.html?itemId=/content/chapter/health_glance2011-35-en
http://stats.oecd.org/index.aspx?queryid=558
http://stats.oecd.org/Index.aspx?DataSetCode=POP_FIVE_HIST
9
Table D2: OECD data for the year 2009 on hip replacement rate, GPD per capita and
population in OECD countries. Countries are ranked by hip replacement rate.
OECD data for the year 2009 on hip replacement rate, GPD per capita and population in
OECD countries. Countries are ranked by hip replacement rate
Country
Germany
Switzerland
Belgium
Austria
Denmark
Norway
France
Luxembourg
Sweden
Netherlands
Slovenia
United Kingdom
Finland
United States
Iceland
Czech Republic
Australia
Italy
New Zealand
Greece
Canada
Ireland
Hungary
Spain
Portugal
Estonia
Slovak Republic
Israel
Poland
Chile
Korea
Mexico
OECD Hip rate GDP per capita
Population (000) in
per 100,000 in (US$ PPP) in 2009
2009
2009
296
287
240
238
236
232
224
222
214
213
194
194
188
184
173
166
154
150
149
140
123
117
99
93
88
88
78
51
44
19
17
8
35.972,6
46.970,2
36.926,5
39.375,4
38.634,8
55.317,0
34.110,8
79.027,0
37.604,7
41.381,7
27.022,5
35.103,2
35.874,0
46.927,2
37.680,5
25.875,2
40.613,2
32.518,7
30.010,2
29.474,9
38.632,1
40.230,5
20.441,4
32.251,3
25.125,3
19.948,2
22.761,1
27.210,1
18.972,0
15.925,0
26.337,5
14.369,6
81.904
7.744
10.796
8.365
5.523
4.829
62.615
498
9.299
16.530
2.042
60.927
5.339
306.772
319
10.491
21.779
59.752
4.316
11.283
33.727
4.537
10.023
45.929
10.568
1.338
5.386
7.486
38.153
16.929
49.182
112.853
The OECD crude rates differ slightly from ECHO crude rates due to subtle differences in the codes used to define a “hip
replacement”. Source: As for Figure D1.