Oliveira C M, Economou T, Bailey T, Mendonça D, Pina M F
INEB, Instituto de Engenharia Biomédica, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal,
Osteoporos Int. 2015 Feb;26(2):489-98. doi: 10.1007/s00198-014-2869-0. Epub 2014 Oct 25.
Age modifies the effect of area-level socioeconomic status (SES) in the risk of fragility hip fractures (HF). For older individuals, the risk of HF increases as SES increases. For younger individuals, risk of HF increases as SES decreases. Our study may help decision-makers to better direct the implementation of political decisions.
The effect of socioeconomic status (SES) on hip fracture (HF) incidence remains unclear. The objective of this study is to evaluate the association between HF incidence and municipality-level SES as well as interactions between age and SES.
From the Portuguese Hospital Discharge Database, we selected hospitalizations (2000-2010) of patients aged 50+, with HF diagnosis (codes 820.x, ICD9-CM), caused by traumas of low/moderate energy, excluding bone cancer cases and readmissions for aftercare. Municipalities were classified according to SES (deprived to affluent) using 2001 Census data. A spatial Bayesian hierarchical regression model (controlling for data heterogeneity and spatial autocorrelation), using the Poisson distribution, was used to quantify the relative risk (RR) of HF, 95% credible interval (95%CrI), and analyze the interaction between age and SES after adjusting for rural conditions.
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 (≥75 years).
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.
年龄会改变地区层面社会经济地位（SES）对髋部脆性骨折（HF）风险的影响。对于老年人而言，HF风险随SES升高而增加。对于年轻人而言，HF风险随SES降低而增加。我们的研究可能有助于决策者更好地指导政策决策的实施。
社会经济地位（SES）对髋部骨折（HF）发病率的影响尚不清楚。本研究的目的是评估HF发病率与市层面SES之间的关联以及年龄与SES之间的相互作用。
从葡萄牙医院出院数据库中，我们选取了年龄在50岁及以上、诊断为HF（国际疾病分类第九版临床修订本[ICD9-CM]编码820.x）、由低/中度能量创伤导致、排除骨癌病例及术后再入院的患者的住院记录（2000 - 2010年）。利用2001年人口普查数据，根据SES（贫困到富裕）对各市进行分类。使用泊松分布的空间贝叶斯分层回归模型（控制数据异质性和空间自相关性）来量化HF的相对风险（RR）、95%可信区间（95%CrI），并在调整农村条件后分析年龄与SES之间的相互作用。
共有96,905例HF，其中77.3%为女性，入院时女性平均年龄高于男性（平均年龄81.2±8.5岁对78.2±10.1岁）（p<0.001）。在女性中，SES越好风险越低：富裕地区与贫困地区相比，RR = 0.83（95%CrI 0.65 - 1.00）。对于男女而言，在最年轻人群中SES与HF发病率呈负相关，在最年老人群中呈正相关，但仅在老年（≥75岁）的贫困地区与富裕地区之间具有显著意义。
SES与年龄之间的相互作用可能归因于生活方式、获得卫生系统服务及预防措施方面的不平等。这些结果可能有助于决策者更好地理解髋部骨折的流行病学情况，并更好地指导可用资金的分配。
