Socioeconomically‐deprived patients suffer hip fractures at a younger age and require more hospital admissions, but early mortality risk is unchanged: The IMPACT Deprivation Study

Abstract

Introduction: Socioeconomic deprivation is associated with multi-morbidity and frailty, but influence on hip fracture outcomes is poorly understood. The primary aim was to investigate the association between deprivation and mortality, and secondary aims were to assess the effects on: (i) age at presentation; (ii) inpatient outcomes, and (iii) post-discharge outcomes.Method: This cohort study included all patients aged >50 years admitted with a hip fracture to a high-volume centre between 01 March 2020 and 20 November 2021.Data were collected contemporaneously by specialist auditors and underwent validation using live health records after 180 days follow-up. Variables were demographics including Scottish Index of Multiple Deprivation, injury and management factors, and outcome measures including length of stay, discharge destination, readmission, and mortality status at 180 days.Results: There were 1822 patients of which 1306/1822 (72%) were female.Deprivation was independently associated with younger age at hip fracture, demonstrating a linear correlation with each deprivation level. The overall mean age was 80.7 years (range 50-102), with the mean age in the most deprived group being 77.2 years (95% CI; 75.7-78.7) versus 82.8 years (95% CI; 82.0-83.5) in the least deprived. Multivariate logistic regression showed no association between deprivation and 30-or 180-day mortality risk. Kaplan-Meier survival analysis demonstrated no difference between the most deprived versus least deprived (log-rank, p = 0.854). Deprivation had no influence on length of stay, discharge destination, or COVID-19 status, but deprived patients had an increased risk of readmission (OR 1.63,; p = 0.003). Conclusion:Deprivation showed no linear correlation with early mortality risk (within 180 days of injury), but it was associated with an earlier age at presentation (the most deprived sustained a hip fracture 5.6 years earlier than the least deprived) which may impact overall life expectancy. More deprived patients were more likely to require further acute hospital admissions.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The incidence of subsequent contralateral hip fracture and factors associated with increased risk: the IMPACT Contralateral Fracture Study

“…To the knowledge of the authors there is no literature describing the influence of socioeconomic deprivation on risk of suffering a contralateral hip fracture. Socioeconomic deprivation is known to influence outcomes following hip fracture, with increasing socioeconomic deprivation associated with higher mortality and younger age at the time of fracture [22], [23], [25].The current study shows deprivation to be associated with a reduced risk of contralateral fracture. The authors recognise that those who are more socioeconomically deprived experience increased frailty, are younger at the time of hip fracture and have increased risk of not returning home following index hip fracture [22], [23], [25], [26].…”

“…Socioeconomic deprivation is known to influence outcomes following hip fracture, with increasing socioeconomic deprivation associated with higher mortality and younger age at the time of fracture [22], [23], [25].The current study shows deprivation to be associated with a reduced risk of contralateral fracture. The authors recognise that those who are more socioeconomically deprived experience increased frailty, are younger at the time of hip fracture and have increased risk of not returning home following index hip fracture [22], [23], [25], [26]. This would suggest that socioeconomic deprivation may increase risk of sustaining a contralateral hip fracture, however this does not seem to be the case.…”

COVID‐19 is associated with increased care needs and a decreased likelihood of returning home following a hip fracture: The IMPACT frailty study

“…It suggests that hip fracture patients that contract COVID‐19 and survive have higher care needs than those that were not directly affected by COVID‐19 within six months of fracture. Socioeconomic deprivation was associated with an increased risk of not returning home, which has been shown to increase the risk of post‐discharge morbidity and readmission to acute services (Kay, Hall, et al., 2022). Extracapsular hip fracture patterns were also associated with an increased risk of not returning home when controlling for confounding factors; one potential explanation is increased perioperative and intraoperative blood loss, as well as an increased risk of blood transfusion (Farrow et al., 2022; Johnston et al., 2010).…”

Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

“…26 This study used an established mechanism for data collection and verification by trained specialist auditors, which has been used in peer-reviewed studies published by the IMPACT Collaborative and SHFA, as well as in annual reporting by Public Health Scotland endorsed by the Scottish Government. 29,30 Hip fracture services at this centre are standardized and delivered according to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP). 3 This has led to collection of granular data with high levels of delirium ascertainment.…”

“…28 This dataset has been used in previously published studies. 29,30 Data were collected and handled as part of service evaluation in accordance with UK Caldicott principles. Statistical analysis.…”