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Social inequality and fractures - secular trends in the Danish population: a case-control study

Social inequality and fractures - secular trends in the Danish population: a case-control study
Social inequality and fractures - secular trends in the Danish population: a case-control study
Purpose/ Introduction: we explored whether the risk of hip, humerus and wrist fracture was associated with markers of inequality using data from Danish health registries.

Methods: all patients 50 years or older with a primary hip (ICD10: S720, S721, S722, and S729) humerus (ICD10: S422, S423, S424, S425, S426, and S427) or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex and year of fracture, to a non-fracture control. Markers of inequality were: Income (fifths); marital status (married, divorced, widowed or unmarried); area of residence (remote, rural, intermediate or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate.

Results: a total of 189,838 fracture patients (37,500 hip; 45,602 humerus; and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9 years (hip), 67.5 years (humerus), and 65.3 years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality.

Conclusion: in conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.
0937-941X
1-8
Hansen, Louise
7c258d12-e38d-4e13-8b98-958ad92544fa
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Vestergaard, Peter
3336d4f1-072c-4b02-935e-a5eca05858e2
Abrahamsen, Bo
ea627e06-482e-479f-8631-5b0f3aec5d13
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Hansen, Louise
7c258d12-e38d-4e13-8b98-958ad92544fa
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Vestergaard, Peter
3336d4f1-072c-4b02-935e-a5eca05858e2
Abrahamsen, Bo
ea627e06-482e-479f-8631-5b0f3aec5d13
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145

Hansen, Louise, Judge, Andrew, Javaid, M. Kassim, Cooper, Cyrus, Vestergaard, Peter, Abrahamsen, Bo and Harvey, Nicholas (2018) Social inequality and fractures - secular trends in the Danish population: a case-control study. Osteoporosis International, 1-8. (doi:10.1007/s00198-018-4603-9).

Record type: Article

Abstract

Purpose/ Introduction: we explored whether the risk of hip, humerus and wrist fracture was associated with markers of inequality using data from Danish health registries.

Methods: all patients 50 years or older with a primary hip (ICD10: S720, S721, S722, and S729) humerus (ICD10: S422, S423, S424, S425, S426, and S427) or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex and year of fracture, to a non-fracture control. Markers of inequality were: Income (fifths); marital status (married, divorced, widowed or unmarried); area of residence (remote, rural, intermediate or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate.

Results: a total of 189,838 fracture patients (37,500 hip; 45,602 humerus; and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9 years (hip), 67.5 years (humerus), and 65.3 years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality.

Conclusion: in conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.

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Danish Inequalities 10_05_2018 R1 clean - Accepted Manuscript
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More information

Accepted/In Press date: 6 June 2018
e-pub ahead of print date: 26 June 2018

Identifiers

Local EPrints ID: 421417
URI: https://eprints.soton.ac.uk/id/eprint/421417
ISSN: 0937-941X
PURE UUID: 5870680c-0f7e-4630-be9d-41d6cc5acba4
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 11 Jun 2018 16:30
Last modified: 10 Dec 2019 05:21

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