Benetou V, Orfanos P, Feskanich D, Michaëlsson K, Pettersson-Kymmer U, Ahmed L A, Peasey A, Wolk A, Brenner H, Bobak M, Wilsgaard T, Schöttker B, Saum K-U, Bellavia A, Grodstein F, Klinaki E, Valanou E, Papatesta E-M, Boffetta P, Trichopoulou A
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.
Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.
Osteoporos Int. 2015 Jun;26(6):1733-46. doi: 10.1007/s00198-015-3054-9. Epub 2015 Mar 28.
The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk.
The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA.
A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models.
Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05).
The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.
社会经济地位在髋部骨折发生率中的作用尚不清楚。在一个多样化的老年人群中，发现受教育程度较高与较低的髋部骨折风险相关，而与已婚/同居相比，独居则与较高的髋部骨折风险相关。教育水平和婚姻状况可能会影响髋部骨折风险。
关于社会经济地位与髋部骨折发生率之间关联的证据有限且不一致。我们调查了欧洲和美国老年人中教育程度和婚姻状况与髋部骨折发生率之间的潜在关联。
来自七个队列的总共155940名60岁及以上的参与者（79%为女性）被随访，共累积了6456例髋部骨折病例。各队列中关于教育程度和婚姻状况的信息进行了统一。通过电话访谈/问卷调查或与登记处的记录链接来确定髋部骨折情况。通过Cox比例风险回归对多个因素进行调整来评估关联。使用随机效应模型得出汇总估计值。
与低教育程度者相比，高教育程度者的髋部骨折风险较低[风险比（HR）=0.84，95%置信区间（CI）0.72 - 0.95]。男性的相应HR为0.97（95%CI 0.82 - 1.13），女性为0.75（95%CI 0.65 - 0.85）。总体而言，与已婚/同居者相比，独居者，尤其是60 - 69岁的独居者，往往有较高的髋部骨折风险（HR = 1.12，95%CI 1.02 - 1.22）。各队列之间没有异质性迹象（异质性P>0.05）。
来自超过150000名60岁及以上个体的综合数据表明，较高的教育程度可能有助于降低髋部骨折风险。此外，与已婚/同居者相比，独居者，尤其是60 - 69岁年龄组的个体，这种风险可能更高。
