Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study

TY - JOUR

T1 - Socioeconomic inequality in clinical outcome among hip fracture patients

T2 - a nationwide cohort study

AU - Kristensen, P K

AU - Thillemann, T M

AU - Pedersen, A B

AU - Søballe, K

AU - Johnsen, S P

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Summary: The evidence is limited regarding the association between socioeconomic status and the clinical outcome among patients with hip fracture. In this nationwide, population-based cohort study, higher education and higher family income were associated with a substantially lower 30-day mortality and risk of unplanned readmission after hip fracture. Introduction: We examined the association between socioeconomic status and 30-day mortality, acute readmission, quality of in-hospital care, time to surgery and length of hospital stay among patients with hip fracture. Methods: This is a nationwide, population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. We identified 25,354 patients ≥65 years admitted with a hip fracture between 2010 and 2013 at Danish hospitals. Individual-level socioeconomic status included highest obtained education, family mean income, cohabiting status and migrant status. We performed multilevel regression analysis, controlling for potential confounders. Results: Hip fracture patients with higher education had a lower 30-day mortality risk compared to patients with low education (7.3 vs 10.0% adjusted odds ratio (OR) = 0.74 (95% confidence interval (CI) (0.63–0.88)). The highest level of family income was also associated with lower 30-day mortality (11.9 vs 13.0% adjusted OR = 0.77, 95% CI 0.69–0.85). Cohabiting status and migrant status were not associated with 30-day mortality in the adjusted analysis. Furthermore, patients with both high education and high income had a lower risk of acute readmission (14.5 vs 16.9% adjusted OR = 0.94, 95% CI 0.91–0.97). Socioeconomic status was, however, not associated with quality of in-hospital care, time to surgery and length of hospital stay. Conclusions: Higher education and higher family income were associated with substantially lower 30-day mortality and risk of readmission after hip fracture.

AB - Summary: The evidence is limited regarding the association between socioeconomic status and the clinical outcome among patients with hip fracture. In this nationwide, population-based cohort study, higher education and higher family income were associated with a substantially lower 30-day mortality and risk of unplanned readmission after hip fracture. Introduction: We examined the association between socioeconomic status and 30-day mortality, acute readmission, quality of in-hospital care, time to surgery and length of hospital stay among patients with hip fracture. Methods: This is a nationwide, population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. We identified 25,354 patients ≥65 years admitted with a hip fracture between 2010 and 2013 at Danish hospitals. Individual-level socioeconomic status included highest obtained education, family mean income, cohabiting status and migrant status. We performed multilevel regression analysis, controlling for potential confounders. Results: Hip fracture patients with higher education had a lower 30-day mortality risk compared to patients with low education (7.3 vs 10.0% adjusted odds ratio (OR) = 0.74 (95% confidence interval (CI) (0.63–0.88)). The highest level of family income was also associated with lower 30-day mortality (11.9 vs 13.0% adjusted OR = 0.77, 95% CI 0.69–0.85). Cohabiting status and migrant status were not associated with 30-day mortality in the adjusted analysis. Furthermore, patients with both high education and high income had a lower risk of acute readmission (14.5 vs 16.9% adjusted OR = 0.94, 95% CI 0.91–0.97). Socioeconomic status was, however, not associated with quality of in-hospital care, time to surgery and length of hospital stay. Conclusions: Higher education and higher family income were associated with substantially lower 30-day mortality and risk of readmission after hip fracture.

KW - 30-day mortality

KW - Hip fracture

KW - Length of stay

KW - Patient readmission

KW - Quality of health care

KW - Social class

UR - https://www.scopus.com/pages/publications/85001043426

U2 - 10.1007/s00198-016-3853-7

DO - 10.1007/s00198-016-3853-7

M3 - Journal article

C2 - 27909785

SN - 0937-941X

VL - 28

SP - 1233

EP - 1243

JO - Osteoporosis International

JF - Osteoporosis International

IS - 4

ER -