The interactions between municipal socioeconomic status and age on hip fracture risk

Abstract

declare that they have no conflict of interest. Role of funding source:The funder Fundação para a Ciência e Tecnologia -FCT has no role in this paper. Mini-abstractAge modifies the effect of area-level socioeconomic status (SES) in the risk of fragility hip fractures (HF).For older individuals risk of HF increases as SES increases. For younger, risk of HF increases as SES decreases. Our study may aid decisions makers and medical guidelines for HF prevention. Background:The effect of socioeconomic status (SES) on hip fracture (HF) incidence remains unclear.Objective: To evaluate the association between HF incidence and municipality-level SES as well as interactions between age and SES. and to analyze the interaction between age and SES, after adjusting for rural conditions. MethodsResults: There were 96,905 HF, 77.3% of which were on women who on average were older than men (mean age 81.2±8.5 vs 78.2±10.1 years) at admission (p<0.001). In women, there was a lower risk associated with better SES: RR=0.83 (95%CrI 0.65-1.00) for affluent versus deprived. There was an inverse association between SES and HF incidence rate in the youngest and a direct association in the oldest, for both sexes, but significant only between deprived and affluent in older ages (≥75years). Conclusions:Interaction between SES and age may be due to inequalities in lifestyles, access to health systems and preventive actions. These results may help decision-makers to better understand the epidemiology of hip fractures and to better direct the available funding.

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000–2010) in Portugal: age and sex temporal trends in a population based study

“…Later, we conducted a hierarchical cluster analysis based on Ward's method to identify homogenous areas. Municipalities were then aggregated in three clusters of SES that were empirically interpreted as follows: the affluent SES comprises municipalities with younger population, higher educational level, higher percentage of employed individuals, good housing conditions (plumbing, heating, shower and bathroom facilities); compared to the affluent areas, the medium SES comprises municipalities with older populations, higher illiteracy rates, a lower gross domestic product (GDP) per capita and a higher percentage of individuals employed in agricultural, forestry and industry; compared to the affluent and medium areas, the deprived SES comprises municipalities with the highest percentage of elderly, the highest illiteracy rate, the highest rate of people living alone, the lowest level of education, the lowest GDP per capita, the highest percentage of individuals with rural activities, the highest percentage of houses with no running water, no shower and bathroom facilities, and the highest percentage of individuals receiving unemployment benefits 28. The population (≥50 years of age) significantly differs by SES group (p<0.001), with the median: 1607 (IQR 1207–2402) in the deprived SES cluster; 3473 inhabitants (IQR 2386–6285) in the medium SES cluster and 7426 inhabitants (IQR 3453–12 706) in the affluent SES cluster.…”

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DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

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