Zhu Qian, Ran Caixia
Department of Orthopedics and Traumatology, The Central Hospital of Enshi Tujia and Miao Autonomous, Hubei, China.
Front Public Health. 2025 Jun 25;13:1601892. doi: 10.3389/fpubh.2025.1601892. eCollection 2025.
Osteoporotic fractures pose a significant public health challenge among the older adult in rural settings with limited healthcare access. This study investigated the burden of osteoporotic fractures, associated care needs, and influencing factors in rural China.
A cross-sectional study was conducted from March 2022 to December 2024, involving older adult individuals aged ≥60 years from rural regions of Enshi Prefecture, Hubei Province, as well as Shandong, Henan, Yunnan, and Gansu provinces in China. Participants were recruited via community health centers, with eligibility confirmed through medical records for osteoporosis or osteoporotic fracture history. A validated 33-item questionnaire assessed demographics, family support, health status, healthcare access, and policy awareness, with logistic regression analyzing factors associated with receiving help after fractures, adjusting for confounders.
Among a total of 3,600 participants, 58.7% reported osteoporotic fractures, with 50.2% experiencing life impact, strongly linked to recent falls (93.2%, < 0.001). Socioeconomic disparities were evident, with insured individuals (OR 2.18, 95% CI 1.95-2.40, < 0.001) and homeowners (OR 2.65, 95% CI 2.40-2.90, < 0.001) more likely to receive help after fractures. Low policy awareness - defined as < 3 correct answers on a (0-6) Rural Health-Policy Knowledge Index - (OR 0.22, 95% CI 0.15-0.30, < 0.001), and a high need for government support (90.1%) highlighted barriers to care. Medical interventions, including supplement use (OR 5.07, 95% CI 4.80-5.35, < 0.001) and osteoporosis treatment (OR 4.51, 95% CI 4.32-4.73, < 0.001), were significantly associated with increased odds of receiving help following osteoporotic fractures. Family support dynamics showed variability, with children helping after fracture reducing formal care access (OR 0.79, 95% CI 0.65-0.95, = 0.013).
Osteoporotic fractures impose a substantial burden on rural Chinese older adult, exacerbated by socioeconomic disparities and low policy awareness. Enhancing insurance coverage, health education, and access to medical interventions is critical to address care inequities and improve outcomes.
骨质疏松性骨折给医疗资源有限的农村老年人带来了重大的公共卫生挑战。本研究调查了中国农村地区骨质疏松性骨折的负担、相关护理需求及影响因素。
于2022年3月至2024年12月进行了一项横断面研究，纳入了来自中国湖北省恩施州农村地区以及山东、河南、云南和甘肃省的60岁及以上老年人。通过社区卫生中心招募参与者，并通过骨质疏松症或骨质疏松性骨折病史的医疗记录确认其 eligibility。一份经过验证的33项问卷评估了人口统计学、家庭支持、健康状况、医疗服务可及性和政策知晓度，并通过逻辑回归分析骨折后获得帮助的相关因素，对混杂因素进行了调整。
在总共3600名参与者中，58.7%报告有骨质疏松性骨折，其中50.2%的生活受到影响，这与近期跌倒密切相关（93.2%，<0.001）。社会经济差异明显，参保者（比值比2.18，95%置信区间1.95 - 2.40，<0.001）和自有住房者（比值比2.65，95%置信区间2.40 - 2.90，<0.001）骨折后更有可能获得帮助。低政策知晓度（定义为农村卫生政策知识指数（0 - 6）上正确答案少于3个）（比值比0.22，95%置信区间0.15 - 0.30，<0.001）以及对政府支持的高需求（90.1%）凸显了护理障碍。包括补充剂使用（比值比5.07，95%置信区间4.80 - 5.35，<0.001）和骨质疏松症治疗（比值比4.51，95%置信区间4.32 - 4.73，<0.001）在内的医疗干预措施与骨质疏松性骨折后获得帮助的几率增加显著相关。家庭支持动态存在差异，骨折后子女提供帮助会减少获得正式护理的机会（比值比0.79，95%置信区间0.65 - 0.95，=0.013）。
骨质疏松性骨折给中国农村老年人带来了沉重负担，社会经济差异和低政策知晓度加剧了这一负担。提高保险覆盖率、健康教育以及获得医疗干预措施的机会对于解决护理不平等问题和改善结果至关重要。
