학술논문
Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study.
Document Type
Academic Journal
Author
Reyes C; Primary Health Care Center Eap Sardenya, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya 466, Barcelona 08025, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.; García-Gil M; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain.; Elorza JM; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.; Fina-Avilés F; Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.; Mendez-Boo L; Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.; Hermosilla E; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.; Coma E; Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.; Carbonell C; Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.; Medina-Peralta M; Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.; Ramos R; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain; Primary Care Services, Girona, Catalan Institute of Health (ICS), Maluquer Salvador 11, Girona 17003, Spain.; Bolibar B; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.; Díez-Pérez A; Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain.; Prieto-Alhambra D; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7HE, United Kingdom.
Source
Publisher: Elsevier Science Country of Publication: United States NLM ID: 8504048 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2763 (Electronic) Linking ISSN: 18732763 NLM ISO Abbreviation: Bone Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: To determine the association between socioeconomic deprivation (SES) and hip fracture risk.
Methods: Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area.
Measures: a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data.
Outcome: incident hip fracture rates as coded in medical records using ICD-10 codes.
Statistics: zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption.
Results: Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference.
Conclusion: Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk.
(Copyright © 2014 Elsevier Inc. All rights reserved.)
Methods: Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area.
Measures: a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data.
Outcome: incident hip fracture rates as coded in medical records using ICD-10 codes.
Statistics: zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption.
Results: Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference.
Conclusion: Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk.
(Copyright © 2014 Elsevier Inc. All rights reserved.)