The interactions between municipal socioeconomic status and age on hip fracture risk (original) (raw)
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Journal of epidemiology and community health, 2016
Socioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000-2010, by regional socioeconomic status (SES), sex and age. We selected registers of patients aged 50+ years with HF (International Classification of Diseases, V.9-Clinical Modification, ICD9-CM) caused by traumas of low/moderate energy, from the National Hospital Discharge Database. Annual time series of age-specific incidence rates were calculated by sex and regional SES (deprived, medium, affluent). Generalised additive models were fitted to identify shape/turning points in temporal trends. We selected 96 905 HF (77.3% in women). Women were older than men at admission (81.2±8.5 vs 78.2±10.1 years-old, p<0.001). For women 65-79 years, a continuously decreasing trend (1.7%/year) only in affluent and increasing trends (3.3-3.4%/year) after 2006/2007 in medium and deprived was observed. For men, trends...
Osteoporosis International, 2002
As many as 40% of hip fractures occur in institutions for the elderly. Several studies have demonstrated a higher age-adjusted incidence of hip fractures in urban areas compared with rural areas. To assess whether this difference could be due to a preferential location of institutions for the elderly in urban areas, we compared the incidence of hip fractures over a 5-year period in urban versus rural areas, as defined according to the population density (urban 415 inhabitants/ha 2 ). We then determined the age-adjusted incidence of hip fractures in institutional-dwelling elderly and home-dwelling elderly. Hip fracture incidence was 100.0/100 000 (150.5 in women and 43.8 in men) in urban areas, and 71.0/100 000 (107.2 in women and 32.8 in men) in rural areas (p50.001). When only those patients living in their own homes were analyzed, the incidence was 66.7/100 000 (94.6 in women and 35.7 in men) in urban regions and 36.8/100 000 (49.6 in women and 23.4 in men) in rural areas (p50.001), a difference of even greater magnitude than when both home-dwelling and institutional-dwelling residents were considered together. In a logistic regression model including age class, gender, urban or rural areas and institutionalization for inhabitants 65 years of age and older, urban residents have a 31% significantly (p50.001) higher incidence of hip fracture compared with rural residents; women have a 79% significantly (p50.001) higher incidence of hip fracture compared with men; and institutional-dwelling elderly have a 351% significantly (p50.001) higher incidence of hip fracture compared with home-dwelling elderly. These results confirm the existence of a higher age-adjusted incidence of hip fractures in urban compared with rural areas. Since this difference is increased when patients living at home were analyzed separately, it indicates that the difference between urban and rural areas is not due to a preferential urban location of institutions for the elderly.
Osteoporosis International, 2008
In this prospective 10-year study in elderly aged 60 years and over, there was a 1.3% per year reduction in the standardized incidence of hip fracture in women but not in men. This decrease was mainly due to changes in the standardized incidence of hip fracture in institutiondwelling women. Introduction A decrease in age-adjusted hip fracture incidence has been recently demonstrated in some countries. Since a large proportion of hip fractures occur in nursing homes, we analyzed whether this decreasing trend would be more detectable in institution-dwelling elderly compared with community-dwelling elderly. Methods All hip fracture patients aged 60 years and over were identified in a well-defined area. Incidence of hip fracture, age-and sex-adjusted to the 2000 Geneva population, was computed in community-and institutiondwelling elderly. Results From 1991 to 2000, 1,624 (41%) hip fractures were recorded in institutionalized-dwelling elderly and 2,327 (59%) in community-dwelling elderly. The standardized fracture incidence decreased by 1.3% per year in women (p=0.039), but remained unchanged in men (+0.5%; p= 0.686). Among institution-dwelling women, hip fracture incidence fell by 1.9% per year (p=0.044), whereas it remained stable among community-dwelling women (+0.0%, p=0.978). In men, no significant change in hip fracture incidence occurred among institution-or communitydwelling elderly. Conclusions The decrease in the standardized hip fracture incidence in institution-dwelling women is responsible for the reversal in secular trend. Future research should include stratification according to the residential status to better identify the causes responsible for the trend in hip fracture incidence.
Maturitas, 2017
Highlights The incidence rate (IR) of hip fracture among women was three times higher than in men. In a population in which 10% of the women were illiterate, illiteracy independently increased the risk of hip fracture in women by 55%. Clinically significant, treatable depression independently increased the risk of hip fracture in women, smoking and disability increased the risk in men, and dementia did not increase the risk in either gender. Gender differences in the incidence of and risk factors for hip fracture: a 16-year longitudinal study in a southern European population Elena Lobo a, b, c (corresponding), Guillermo Marcos a,b, c, d , Javier Santabárbara a, b, c , Helena
Risk factors for hip fracture in european women: The MEDOS study
Journal of Bone and Mineral Research, 2009
The aims of this study were to determine common international risk factors for hip fracture in women aged 50 years or more. We studied women aged 50 years or more who sustained a hip fracture in 14 centers from Portugal, Spain, France, Italy, Greece, and Turkey over a 1-year period. Women aged 50 years or more selected from the neighborhood or population registers served as controls. Cases and controls were interviewed using a structured questionnaire on work, physical activity, exposure to sunlight, reproductive history and gynecologic status, height, weight, mental score, and consumption of tobacco, alcohol, calcium, coffee, and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), short fertile period, low physical activity, lack of sunlight exposure, low milk consumption, no consumption of tea, and a poor mental score. No significant adverse effects of coffee or smoking were observed. Moderate intake of spirits was a protective factor in young adulthood, but otherwise no significant effect of alcohol intake was observed. For some risks, a threshold effect was observed. A low BMI and milk consumption were significant risks only in the lowest 50% and 10% of the population, respectively. A late menarche, poor mental score, low BMI and physical activity, low exposure to sunlight, and a low consumption of calcium and tea remained independent risk factors after multivariate analysis, accounting for 70%0 of hip fractures. Excluding mental score and age at menarche (not potentially reversible), the attributable risk was 56%. Thus, about half of the hip fractures could be explained on the basis of the potentially reversible risk factors sought. In contrast, the use of risk factors to "predict" hip fractures had moderate sensitivity and specificity. We conclude that variations in lifestyle factors are associated with significant differences in the risk of hip fracture, account for a large component of the total risk, and may be of some value in selecting individuals at high risk. (J Bone Miner Res 1995;101802-1815)
Change in hip fracture incidence over the last 6 years in France
Osteoporosis International, 2011
Controversies exist about the change in hip fracture incidence among countries. In France, over the last 6 years, the incidence in people aged 40 years and over of hip fractures decreased in women over 39 years and increased in men; a decrease in the incidence was observed in both genders in the elderly. Introduction Controversies exist about the change in hip fracture incidence among countries. The aim of this study was to assess the incidence of hip fractures in men and women aged 40 years and over between 2002 and 2008 in France. Methods Data were drawn from the French Hospital National Database. The absolute number of admissions was described and the incidence rates per 1,000,000 adjusted on age (40-59, 60-74; 74-84, and ≥85 years), and gender was calculated using the data of the French population.
Changing trends in the epidemiology of hip fracture in Spain
Osteoporosis International, 2014
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Incidence of hip fracture over a 10-year period (1991–2000): Reversal of a secular trend
Bone, 2007
Introduction: Hip fractures are a major cause of burden associated with osteoporosis in terms of mortality, disability, and costs. With the ageing of the population, a marked increase in the number of fractures is expected. Furthermore, many studies reveal an increase of the age-adjusted hip fracture incidence. We specifically examined secular changes in the incidence of hip fracture in women and men aged 50 years and over in the well-defined area of Geneva, Switzerland. Materials and methods: All hip fractured patients were retrospectively identified from the computer medical records of the main hospital, which is receiving 95% of hip fractures occurring in a well-defined area. Results: From 1991 to 2000, 4115 hip fractures were recorded in 2981 women and 822 men with a mean age (±S.D.) of 83.1 ± 8.9 and 78.3 ± 11.6 years, respectively. A second hip fracture occurred in 276 women (9.3%) and 36 men (4.4%), on average 2.1 ± 1.9 (median 1.44) years after the first event without gender difference. The overall incidence of hip fractures was 455 (95% CI: 439-471) per 100,000 person-years in women and 153 (95% CI: 143-163) in men. The number of hip fractures remained constant (412 (95% CI: 397-426)), but the mean age of these patients increased each year by 0.13 year in women (p = 0.019) and by 0.04 year in men (NS). Furthermore, the age-adjusted incidence of hip fractures, standardized to the 2000 Geneva population, decreased significantly by 1.4% (95% CI: −2.6 to −0.1) per year in women (p = 0.021), but remained stable in men (0.5% (95% CI: −1.7 to + 2.8) per year, p = 0.66). The overall female/male ratio of hip fracture incidence was 2.99 (95% CI: 2.80-3.18, p < 0.001) and significantly decreased by 0.07 (95% CI: −0.13 to − 0.01) per year (p = 0.024). Conclusion: Despite an increase in the population at risk and in the mean age of hip fractured women, there was a significant decrease in ageadjusted incidence in women but not in men. These results may suggest a reversal of the previously observed secular trend.
A seventy percent overestimation of the burden of hip fractures in women aged 85 and over
Bone, 2007
Background: Hip fractures are the most devastating result of osteoporosis and are common worldwide. Based on an exponential increase in incidence with age, many studies in the 1990s forecasted an epidemic of hip fracture in women in the next 15 years which is not currently being observed. Despite the ageing of the populations, accurate description of hip fracture incidence in women aged 85 or older are scarce. Methods: All women aged 60 to 95, living in the Rhône-Alpes area of France, who were admitted to hospitals during 2001-2004 for treatment of hip fracture were selected from the French claims databases. An exponential model was tested to describe the increase in hip fracture incidence in women aged 60-84 and 60-95. The first model was used to predict annual hip fracture incidence in women aged 85-95 in the Rhône-Alpes area, in France and in Europe.