Socio-economic inequalities in fragility fracture outcomes

a systematic review and meta-analysis of prognostic observational studies

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

*Corresponding author for this work

Research output: Contribution to journalReviewResearchpeer-review

Abstract

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.

Original languageEnglish
JournalOsteoporosis International
ISSN0937-941X
DOIs
Publication statusE-pub ahead of print - 30. Aug 2019

Fingerprint

Meta-Analysis
Quality of Life
Odds Ratio
PubMed
Databases

Keywords

  • Fractures
  • Health-related quality of life
  • Inequality
  • Mortality
  • Socio-economic status

Cite this

Valentin, G. ; Pedersen, S. E. ; Christensen, R. ; Friis, K. ; Nielsen, C. P. ; Bhimjiyani, A. ; Gregson, C. L. ; Langdahl, B. L. / Socio-economic inequalities in fragility fracture outcomes : a systematic review and meta-analysis of prognostic observational studies. In: Osteoporosis International. 2019.
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title = "Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies",
abstract = "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",
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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.

In: Osteoporosis International, 30.08.2019.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - Socio-economic inequalities in fragility fracture outcomes

T2 - a systematic review and meta-analysis of prognostic observational studies

AU - Valentin, G.

AU - Pedersen, S. E.

AU - Christensen, R.

AU - Friis, K.

AU - Nielsen, C. P.

AU - Bhimjiyani, A.

AU - Gregson, C. L.

AU - Langdahl, B. L.

PY - 2019/8/30

Y1 - 2019/8/30

N2 - 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.

AB - 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.

KW - Fractures

KW - Health-related quality of life

KW - Inequality

KW - Mortality

KW - Socio-economic status

U2 - 10.1007/s00198-019-05143-y

DO - 10.1007/s00198-019-05143-y

M3 - Review

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

ER -