髋部骨折发病率与社会剥夺：来自法国的一项生态学研究结果。
Hip fracture incidence and social deprivation: results from a French ecological study.
机构信息
Department of Medicine, Division of Rheumatology, University Hospital Center of Caen, Avenue de la Côte de Nacre, 14033, Caen cedex 9, France.
INSERM Research U1086 Cancers and Preventions, Avenue du Général Harris, 14076, Caen, France.
出版信息
Osteoporos Int. 2017 Jul;28(7):2045-2051. doi: 10.1007/s00198-017-3998-z. Epub 2017 Mar 23.
UNLABELLED
The association between socioeconomic status (SES) and hip fracture (HF) incidence was analyzed in France in 2008. In men and women, a decrease in HF incidence was observed as the social deprivation index increased. This result may be partly due to the protective effect of increasing body weight against HF.
INTRODUCTION
Regional variations in hip fracture (HF) incidence exist worldwide. Reasons for these variations remain unknown. As regional variations have also been observed for socioeconomic status, we analyzed the association between socioeconomic deprivation (SED) and HF incidence in France in 2008.
METHODS
From the French Hospital National Database, we selected all HF encoded as primary diagnosis in persons aged 30 years and over. The recently published French version of the European Deprivation Index (EDI) was used for SED analysis, and an EDI score was measured for the year 2007 in each French local municipality. The EDI score was categorized in quintiles. Poisson regression was performed to examine the association between HF incidence and EDI adjusted for age and sex. The population attributable fraction (PAF) was measured to calculate the proportion of excess cases of HF associated with social affluence.
RESULTS
In 2008, 83,538 HF were reported in France of which 59,143 were included in this study. Among them, 44,401 fractures occurred in women (75%) and 14,742 in men (25%). In both men and women, there was a decrease in the HF incidence with increasing SED index. In Poisson regression, the interaction of age class and sex was significant (p < 0.0001) and the EDI in quintiles was significantly associated with the incidence of HF (p < 0.0001). A higher number of people living in affluent residential areas corresponded to a higher risk of HF. The risk of HF is 2.42 times higher for those living in the most affluent group compared to those living in the most underprivileged group. The value of the PAF was calculated at 27.1%.
CONCLUSION
Social disparities in HF incidence exist in France with the most deprived municipalities having the lowest incidence. Prior knowledge demonstrates the strong relationships between body weight and HF risk as well as between body weight and the SED. The link found in our study between EDI and HF incidence as well as regional and temporal variations in HF incidence may be partly due to the protective effect of increased body weight against HF.
目的
分析 2008 年法国社会经济地位（SES）与髋部骨折（HF）发病率之间的关系。在男性和女性中，随着社会剥夺指数的增加，HF 发病率呈下降趋势。这一结果可能部分归因于体重增加对 HF 的保护作用。
背景
全球范围内存在髋部骨折（HF）发病率的区域差异。这些差异的原因尚不清楚。由于 SES 也存在区域差异，我们分析了 2008 年法国 SES 与 HF 发病率之间的关系。
方法
从法国国家医院数据库中，我们选择了所有年龄在 30 岁及以上的编码为原发性诊断的 HF 患者。使用最近发表的法国版欧洲剥夺指数（EDI）进行 SES 分析，并为每个法国地方自治市测量了 2007 年的 EDI 评分。EDI 评分分为五分位数。采用泊松回归分析年龄和性别调整后的 HF 发病率与 EDI 之间的关系。测量人群归因分数（PAF）以计算与社会富裕相关的 HF 超额病例的比例。
结果
2008 年，法国报告了 83538 例 HF，其中 59143 例纳入本研究。其中，44401 例骨折发生在女性（75%），14742 例发生在男性（25%）。在男性和女性中，随着 SES 指数的增加，HF 发病率呈下降趋势。在泊松回归中，年龄组和性别的交互作用具有统计学意义（p<0.0001），五分位数 EDI 与 HF 发病率显著相关（p<0.0001）。居住在富裕地区的人数越多，HF 的风险越高。与居住在最贫困组的人相比，居住在最富裕组的人 HF 的风险高 2.42 倍。PAF 的值计算为 27.1%。
结论
法国 HF 发病率存在社会差异，最贫困的市镇发病率最低。既往研究证明，体重与 HF 风险以及体重与 SES 之间存在很强的关系。我们在研究中发现 EDI 与 HF 发病率之间的联系以及 HF 发病率的区域和时间变化，部分可能归因于体重增加对 HF 的保护作用。
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