Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark.
University of Bristol, Bristol, England.
Osteoporos Int. 2018 Oct;29(10):2243-2250. doi: 10.1007/s00198-018-4603-9. Epub 2018 Jun 26.
We examined links between markers of social inequality and fracture risk in the Danish population, demonstrating that high income and being married are associated with a significantly lower risk.
We explored whether the risk of hip, humerus, and wrist fracture was associated with markers of inequality using data from Danish health registries.
All patients 50 years or older with a primary hip (ICD10 S720, S721, S722, and S729) humerus (ICD10 S422, S423, S424, S425, S426, and S427), or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex, and year of fracture, to a non-fracture control. Markers of inequality were as follows: income (fifths); marital status (married, divorced, widowed, or unmarried); area of residence (remote, rural, intermediate, or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol, and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate.
A total of 189,838 fracture patients (37,500 hip, 45,602 humerus, and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9 years (hip), 67.5 years (humerus), and 65.3 years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality.
In conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.
我们研究了丹麦人群中社会不平等标志物与骨折风险之间的关系，结果表明高收入和已婚状态与较低的骨折风险显著相关。
我们使用丹麦健康登记处的数据，探索了髋部、肱骨和腕部骨折风险与不平等标志物之间的关系。所有年龄在 50 岁及以上的初次髋部（ICD10 S720、S721、S722 和 S729）、肱骨（ICD10 S422、S423、S424、S425、S426 和 S427）或腕部（ICD10：S52）骨折患者，均来自 1995 年 1 月 1 日至 2011 年 12 月 31 日的数据。骨折患者按年龄、性别和骨折年份与非骨折对照组 1:1 匹配。不平等标志物如下：收入（五分位数）；婚姻状况（已婚、离婚、丧偶或未婚）；居住地（偏远、农村、中等或城市）。采用条件逻辑回归，在调整吸烟、饮酒和 Charlson 合并症等混杂因素后，调查这些暴露与骨折风险之间的关系。在适当的情况下，在暴露与混杂因素之间拟合交互作用。
共纳入 189838 例骨折患者（37500 例髋部骨折、45602 例肱骨骨折和 106736 例腕部骨折）和 189838 例对照组。平均年龄为 73.9 岁（髋部）、67.5 岁（肱骨）和 65.3 岁（腕部）。与平均收入（五分位数 3）相比，高收入（五分位数 5）显著降低了所有三种骨折的比值比。已婚患者在所有三种骨折中发生的比值比均显著降低。然而，在不平等标志物的影响方面，并未观察到整体的时间趋势差异。
总之，我们在人群水平上证明了社会不平等（使用收入、婚姻状况和居住地来评估）与骨折之间存在重要且稳定的关联。这些发现可以为医疗保健方法提供信息，并表明应该特别关注独居者的新干预措施，并尽可能采取社会措施来减少社会不平等。
