Socio-economic inequalities in fragility fracture outcomes:​ a systematic review and meta-analysis of prognostic observational studies

Valentin, G.; Pedersen, S. E.; Christensen, R.; Friis, K.; Nielsen, C. P.; Bhimjiyani, A.; Gregson, C. L.; Langdahl, B. L.

Affiliations

¹Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Denmark

²Musculoskeletal Statistics Unit, The Parker Institute, Bispeberg and Frederiksberg Hospital & Research Unit of Rhematology, Copenhagen, Denmark & Department of Clinical Researh University of Southern Denmark, Odense University Hospital, Odense, Denmark

³Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK

⁴Department of Endocrinology (MEA), Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

Abstract and keywords

Summary: Individuals with low socio-economic status (SES) have a higher risk of dying following hip fracture compared with individuals with high SES. Evidence on social inequalities in non-hip fractures is lacking as well as evidence on the impact of SES on health-related quality of life post fracture.

Introduction: Fragility fractures, especially of the hip, cause substantial excess mortality and impairment in health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate the association between socio-economic status (SES) and post-fracture mortality and HRQoL.

Methods: PubMed, EMBASE and CINAHL databases were searched from inception to the last week of November 2018 for studies reporting an association between SES and post-fracture mortality and/or HRQoL among people aged ≥ 50 years. Risk ratios (RRs) were meta-analyzed using a standard inverse-variance-weighted random effects model. Studies using individual-level and area-based SES measures were analyzed separately.

Results: A total of 24 studies from 15 different countries and involving more than one million patients with hip fractures were included. The overall risk of mortality within 1-year post-hip fracture in individuals with low SES was 24% higher than in individuals with high SES (RR 1.24, 95% CI 1.19 to 1.29) for individual-level SES measures, and 14% (RR 1.14, 95% CI 1.09 to 1.19) for area-based SES measures. The quality of the evidence for the outcome mortality was moderate. Using individual SES measures, we estimated the excess HRQoL loss to be 5% (95% CI − 1 to 10%) among hip fracture patients with low SES compared with high SES.

Conclusions: We found a consistently increased risk of post-hip fracture mortality with low SES across SES measures and across countries with different political structures and different health and social care infrastructures. The impact of SES on post-fracture HRQoL remains uncertain due to sparse and low-quality evidence.

Keywords: Fractures; Health-related quality of life; Inequality; Mortality; Socio-economic status

Links

DOI: 10.1007/s00198-019-05143-y

PubMed: 31720721

WoS: 000495937900002

History

Received: 2019-06-27

Accepted: 2019-08-20

Online: 2019-08-30

Cited Works (2)

Year	Entry
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
2010	Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. March 16, 2010;152(6):380-390.

Cited By (1)

Year	Entry
2021	Valentin G, Friis K, Nielsen CP, Larsen FB, Langdahl BL. Fragility fractures and health-related quality of life: does socio-economic status widen the gap? a population-based study. Osteoporos Int. January 2021;32(1):63-73.