Toggle Main Menu Toggle Search

Open Access padlockePrints

An ecological study of publicly funded elective hip arthroplasties in Brazil and Scotland: do access inequalities reinforce the inverse care law?

Lookup NU author(s): Professor Allyson PollockORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


ObjectivesTo compare elective hip arthroplasty rates funded by the public sector in Brazil and Scotland.DesignEcological study, 2009-13, of crude and directly standardised rates of elective primary hip arthroplasty rates (per 100,000) funded by the public sector at national and regional level for age (30 years +) and gender in Brazil and Scotland.Setting National Health Service Scotland and Unified Health System in Brazil. ParticipantsOver 30s population who had undergone an elective hip arthroplasty funded by the public sector.Main outcome measuresPublicly funded standardised elective hip arthroplasty rates in Brazil and Scotland ResultsBetween 2009 and 2013, there was a seven-fold difference in treatment rates between Brazil and Scotland, and an eight-fold regional difference in Brazil; Brazil (7.8 to 8.3/100,000, increase of 0.5 per 100,000, 95% C.I. (0.3, 0.7) from 2009/10 to 2012/13) and Scotland (from 61.1 to 57.7/100,000, decrease of 3.4 per 100,000, 95% C.I. (1.4, 5.8) per 100,000); a twofold difference in number of public beds per head of population (Brazil 158.3/100,000 vs. Scotland 305.1/100,000) and general medical workforce (Brazil 198.8/100,000 vs. Scotland 327.4/100,000); numbers of orthopaedic surgeons per head of population in the two countries were similar in 2013 (Brazil 5.2/100,000 vs. Scotland 4.3/100,000). ConclusionDistribution of specialists and higher treatment rates in Brazil is highly skewed towards wealthier areas perpetuating historical regional inequalities.

Publication metadata

Author(s): Filippon J, Bremner S, Giovanella L, Pollock AM

Publication type: Article

Publication status: Published

Journal: Journal of the Royal Society of Medicine

Year: 2020

Volume: 11

Issue: 5

Pages: 1-7

Print publication date: 01/05/2020

Online publication date: 06/05/2020

Acceptance date: 02/04/2020

Date deposited: 29/01/2020

ISSN (print): 0141-0768

ISSN (electronic): 1758-1095

Publisher: Sage Publications Ltd.


DOI: 10.1177/2054270420920772


Altmetrics provided by Altmetric


Funder referenceFunder name
National Council for Scientific and Technological Development of Brazil (CNPq)