The interactions between municipal socioeconomic status and age on hip fracture risk (original) (raw)

2014, Osteoporosis International

Abstract

Age modifies the effect of area-level socioeconomic status (SES) in the risk of fragility hip fractures (HF). For older individuals risk of HF increases as SES increases. For younger, risk of HF increases as SES decreases. Our study may aid decisions makers and medical guidelines for HF prevention. Background: The effect of socioeconomic status (SES) on hip fracture (HF) incidence remains unclear. Objective: To evaluate the association between HF incidence and municipality-level SES as well as interactions between age and SES. Methods: From the Portuguese Hospital Discharge Database we selected hospitalizations (2000-2010) of patients aged 50+, with HF diagnosis (codes 820.x, ICD9.CM), caused by traumas of low/moderate energy, excluding bone cancer cases and readmissions for after-care. Municipalities were classified according to SES (deprived to affluent) using 2001 Census data. A spatial Bayesian hierarchical regression model (controlling for data heterogeneity effect and spatial autocorrelation), using the Poisson distribution, was used to quantify the Relative Risk (RR) of HF, 95% credible interval (95%CrI), and to analyze the interaction between age and SES, after adjusting for rural conditions. Results: There were 96,905 HF, 77.3% of which were on women who on average were older than men (mean age 81.2±8.5 vs 78.2±10.1 years) at admission (p<0.001). In women, there was a lower risk associated with better SES: RR=0.83 (95%CrI 0.65-1.00) for affluent versus deprived. There was an inverse association between SES and HF incidence rate in the youngest and a direct association in the oldest, for both sexes, but significant only between deprived and affluent in older ages (≥75years). Conclusions: Interaction between SES and age may be due to inequalities in lifestyles, access to health systems and preventive actions. These results may help decision-makers to better understand the epidemiology of hip fractures and to better direct the available funding.

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