Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Denmark.
Musculoskeletal Statistics Unit, The Parker Institute, Bispeberg and Frederiksberg Hospital & Research Unit of Rhematology, Copenhagen, Denmark & Department of Clinical Researh University of Southern Denmark, Odense University Hospital, Odense, Denmark.
Osteoporos Int. 2020 Jan;31(1):31-42. doi: 10.1007/s00198-019-05143-y. Epub 2019 Aug 30.
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.
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.
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.
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.
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.
与社会经济地位（SES）较高的个体相比，SES 较低的个体在髋部骨折后死亡的风险更高。非髋部骨折的社会不平等证据以及 SES 对骨折后健康相关生活质量（HRQoL）的影响的证据都很缺乏。
脆性骨折，特别是髋部骨折，会导致死亡率显著增加和 HRQoL 受损。本系统评价和荟萃分析旨在研究 SES 与骨折后死亡率和 HRQoL 之间的关系。
从建库至 2018 年 11 月最后一周，在 PubMed、EMBASE 和 CINAHL 数据库中检索报告 SES 与≥50 岁人群骨折后死亡率和/或 HRQoL 之间关系的研究。使用标准逆方差加权随机效应模型对风险比（RR）进行荟萃分析。分别分析使用个体水平和基于区域的 SES 测量的研究。
纳入了来自 15 个不同国家的 24 项研究，涉及超过 100 万例髋部骨折患者。SES 较低的个体在髋部骨折后 1 年内的总体死亡率比 SES 较高的个体高 24%（RR 1.24，95%CI 1.19 至 1.29），对于个体水平的 SES 测量，对于基于区域的 SES 测量则为 14%（RR 1.14，95%CI 1.09 至 1.19）。结局死亡率的证据质量为中等。使用个体 SES 测量，我们估计 SES 较低的髋部骨折患者与 SES 较高的患者相比，HRQoL 损失超过 5%（95%CI -1 至 10%）。
我们发现，无论 SES 测量方法如何，无论国家的政治结构、卫生和社会保健基础设施如何不同，SES 较低与髋部骨折后死亡率增加均存在一致性关联。由于证据稀疏且质量较低，SES 对骨折后 HRQoL 的影响仍不确定。
