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Epidemiology of fractures in the United Kingdom 1988-2012: variation with age, sex, geography, ethnicity and socioeconomic status

Epidemiology of fractures in the United Kingdom 1988-2012: variation with age, sex, geography, ethnicity and socioeconomic status
Epidemiology of fractures in the United Kingdom 1988-2012: variation with age, sex, geography, ethnicity and socioeconomic status
Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained.

INTRODUCTION: With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status.

METHODS: The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ?18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age and sex-specific fracture incidence rates were calculated.

RESULTS: Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1.

CONCLUSIONS: This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services.
epidemiology, osteoporosis, fractures, incidence, ethnicity, geography, sex, socioeconomic status
8756-3282
19-26
Curtis, E.M.
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
van der Velde, R.
d26b6e7e-fbc8-40cb-b4b3-b14b3c963337
Moon, R.J.
954fb3ed-9934-4649-886d-f65944985a6b
van den Bergh, J.P.
44d39933-c982-41e8-a5ed-3f48b7ff0c47
Geusens, P.
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de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
van Staa, T.P.
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Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Curtis, E.M.
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
van der Velde, R.
d26b6e7e-fbc8-40cb-b4b3-b14b3c963337
Moon, R.J.
954fb3ed-9934-4649-886d-f65944985a6b
van den Bergh, J.P.
44d39933-c982-41e8-a5ed-3f48b7ff0c47
Geusens, P.
4ff22618-fc20-494f-aa5d-2747d6b66f65
de Vries, F.
db4c0543-d6e7-476b-a10e-52d9d483f613
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145

Curtis, E.M., van der Velde, R., Moon, R.J., van den Bergh, J.P., Geusens, P., de Vries, F., van Staa, T.P., Cooper, C. and Harvey, N.C. (2016) Epidemiology of fractures in the United Kingdom 1988-2012: variation with age, sex, geography, ethnicity and socioeconomic status. Bone, 87, 19-26. (doi:10.1016/j.bone.2016.03.006). (PMID:26968752)

Record type: Article

Abstract

Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained.

INTRODUCTION: With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status.

METHODS: The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ?18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age and sex-specific fracture incidence rates were calculated.

RESULTS: Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1.

CONCLUSIONS: This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services.

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Accepted/In Press date: 7 March 2016
e-pub ahead of print date: 9 March 2016
Published date: June 2016
Keywords: epidemiology, osteoporosis, fractures, incidence, ethnicity, geography, sex, socioeconomic status
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 389751
URI: http://eprints.soton.ac.uk/id/eprint/389751
ISSN: 8756-3282
PURE UUID: 2662c6d4-f0f1-4447-b454-5c748e4a5f4a
ORCID for E.M. Curtis: ORCID iD orcid.org/0000-0002-5147-0550
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 14 Mar 2016 14:37
Last modified: 31 Jan 2020 05:02

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