nach oben

Erschienen in:

01.06.2015 | Original Article

Education, marital status, and risk of hip fractures in older men and women: the CHANCES project

verfasst von: V. Benetou, P. Orfanos, D. Feskanich, K. Michaëlsson, U. Pettersson-Kymmer, L. A. Ahmed, A. Peasey, A. Wolk, H. Brenner, M. Bobak, T. Wilsgaard, B. Schöttker, K.-U. Saum, A. Bellavia, F. Grodstein, E. Klinaki, E. Valanou, E.-M. Papatesta, P. Boffetta, A. Trichopoulou

Erschienen in: Osteoporosis International | Ausgabe 6/2015

Einloggen, um Zugang zu erhalten

Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

Nur mit Berechtigung zugänglich

Cooper C, Cole ZA, Holroyd CR et al (2011) IOF CSA working group on fracture epidemiology. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288PubMedCentralPubMedCrossRef

Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international osteoporosis foundation (IOF) and the European federation of pharmaceutical industry associations (EFPIA). Arch Osteoporos 8(1–2):136PubMedCentralPubMedCrossRef

Antonovsky A (1967) Social class, life expectancy and overall mortality. Milbank Mem Fund Q 45(2):31–73PubMedCrossRef

Feinstein JS (1993) The relationship between socioeconomic status and health: a review of the literature. Milbank Q 71(2):279–322PubMedCrossRef

Mackenbach JP, Stirbu I, Roskam AJ et al (2008) European union working group on socioeconomic inequalities in health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23):2468–2481PubMedCrossRef

Adler NE, Stewart J (2010) Using team science to address health disparities: MacArthur network as case example. Ann N Y Acad Sci 1186:252–260PubMedCrossRef

Dupre ME, Meadow SO (2007) Disaggregating the effects of marital trajectories on health. J Fam Issues 28:623–652CrossRef

Robards J, Evandrou M, Falkingham J, Vlachantoni A (2012) Marital status, health and mortality. Maturitas 73(4):295–299PubMedCentralPubMedCrossRef

Johnell O, Borgstrom F, Jonsson B, Kanis J (2007) Latitude, socioeconomic prosperity, mobile phones and hip fracture risk. Osteoporos Int 18(3):333–337PubMedCrossRef

10.

Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C, IOF Working Group on Epidemiology and Quality of Life (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23(9):2239–2256PubMedCentralPubMedCrossRef

11.

Farahmand BY, Persson PG, Michaëlsson K, Baron JA, Parker MG, Ljunghall S (2000) Swedish hip fracture group. Socioeconomic status, marital status and hip fracture risk: a population-based case–control study. Osteoporos Int 11(9):803–808PubMedCrossRef

12.

Zigmond DS, Soohoo NF, Silverman SL (2006) The role of socioeconomic status on hip fracture. Osteoporos Int 17(10):1562–1568CrossRef

13.

Brennan SL, Henry MJ, Kotowicz MA, Nicholson GC, Zhang Y, Pasco JA (2011) Incident hip fracture and social disadvantage in an Australian population aged 50 years or greater. Bone 48(3):607–610PubMedCrossRef

14.

Guilley E, Herrmann F, Rapin CH, Hoffmeyer P, Rizzoli R, Chevalley T (2011) Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly. Osteoporos Int 22(2):647–653PubMedCrossRef

15.

Quah C, Boulton C, Moran C (2011) The influence of socioeconomic status on the incidence, outcome and mortality of fractures of the hip. J Bone Joint Surg (Br) 93(6):801–805CrossRef

16.

Crandall CJ, Han W, Greendale GA et al (2014) Socioeconomic status in relation to incident fracture risk in the study of women’s health across the nation. Osteoporos Int 25(4):1379–1388PubMedCentralPubMedCrossRef

17.

Reimers A, Laflamme L (2007) Hip fractures among the elderly: personal and contextual social factors that matter. J Trauma 62(2):365–369PubMedCrossRef

18.

Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20(9):1487–1497PubMedCrossRef

19.

Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case–control study from Denmark. Scand J Public Health 34(4):371–377PubMedCrossRef

20.

Syddall HE, Evandrou M, Dennison EM et al (2012) Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire cohort study. Arch Osteoporos 7(1–2):37–48PubMedCentralPubMedCrossRef

21.

Boffetta P, Bobak M, Borsch-Supan A et al (2014) The consortium on health and ageing: network of cohorts in Europe and the United States (CHANCES) project-design, population and data harmonization of a large-scale, international study. Eur J Epidemiol 29(12):929–36PubMedCrossRef

22.

Trichopoulou A, Orfanos P, Norat T et al (2005) Modified mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991PubMedCentralPubMedCrossRef

23.

Gao L, Weck MN, Michel A, Pawlita M, Brenner H (2009) Association between chronic atrophic gastritis and serum antibodies to 15 Helicobacter pylori proteins measured by multiple serology. Cancer Res 69(7):2973–2980PubMedCrossRef

24.

Ahmed LA, Schirmer H, Bjørnerem A et al (2009) The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol 24(8):441–448PubMedCrossRef

25.

Harris H, Håkansson N, Olofsson C, Julin B, Åkesson A, Wolk A (2013) The Swedish mammography cohort and the cohort of Swedish men: study design and characteristics of two population-based longitudinal cohorts. OA Epidemiology 1(2):16CrossRef

26.

Colditz GA, Hankinson SE (2005) The nurses’ health study: lifestyle and health among women. Nat Rev Cancer 5(5):388–396PubMedCrossRef

27.

Gedeborg R, Engquist H, Berglund L, Michaelsson K (2008) Identification of incident injuries in hospital discharge registers. Epidemiology 19(6):860–867PubMedCrossRef

28.

Colditz GA, Martin P, Stampfer MJ et al (1986) Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol 123(5):894–900PubMed

29.

Ludvigsson JF, Andersson E, Ekbom A et al (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450PubMedCentralPubMedCrossRef

30.

Wilson RT, Chase GA, Chrischilles EA, Wallace RB (2006) Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators. Am J Public Health 96(7):1210–1218PubMedCentralPubMedCrossRef

31.

Bacon WE, Hadden WC (2000) Occurrence of hip fractures and socioeconomic position. J Aging Health 12(2):193–203PubMedCrossRef

32.

Icks A, Haastert B, Wildner M et al (2009) Hip fractures and area level socioeconomic conditions: a population-based study. BMC Public Health 9:114PubMedCentralPubMedCrossRef

33.

Laaksonen M, Talala K, Martelin T et al (2008) Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years. Eur J Public Health 18(1):38–43PubMedCrossRef

34.

Kanis JA, Johnell O, Odén A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16(2):155–162PubMedCrossRef

35.

Benetou V, Orfanos P, Benetos IS et al (2011) Anthropometry, physical activity and hip fractures in the elderly. Injury 42(2):188–193PubMedCrossRef

36.

Berg KM, Kunins HV, Jackson JL et al (2008) Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med 121(5):406–418PubMedCentralPubMedCrossRef

37.

Coulson CE, Williams LJ, Henry MJ et al (2010) Patterns of alcohol use and associated physical and lifestyle characteristics according to new Australian guidelines. Aust N Z J Psychiatry 44(10):946–51PubMedCrossRef

38.

McLaren L (2007) Socioeconomic status and obesity. Epidemiol Rev 29:29–48PubMedCrossRef

39.

Johansson H, Kanis JA, Odén A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29(1):223–233PubMedCrossRef

40.

Brennan SL, Henry MJ, Nicholson GC, Kotowicz MA, Pasco JA (2009) Socioeconomic status and risk factors for obesity and metabolic disorders in a population-based sample of adult females. Prev Med 49(2–3):165–71PubMedCrossRef

41.

Södergren M, Wang WC, Salmon J, Ball K, Crawford D, McNaughton SA (2014) Predicting healthy lifestyle patterns among retirement age older adults in the WELL study: a latent class analysis of sex differences. Maturitas 77(1):41–6PubMedCrossRef

42.

Manzoli L, Villari P, Pirone GM, Boccia A (2007) Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med 64(1):77–94PubMedCrossRef

43.

Goldman N, Korenman S, Weinstein R (1995) Marital status and health among the elderly. Soc Sci Med 40(12):1717–1730PubMedCrossRef

44.

Staehelin K, Schindler C, Spoerri A, Zemp Stutz E, Swiss National Cohort Study Group (2012) Marital status, living arrangement and mortality: does the association vary by gender? J Epidemiol Community Health 66(7):e22PubMedCrossRef

45.

Dykstra PA, de Jong GJ (2004) Gender and marital-history differences in emotional and social loneliness among Dutch older adults. Can J Aging 23(2):141–155PubMedCrossRef

46.

Schousboe JT, Paudel ML, Taylor BC et al (2013) Magnitude and consequences of misclassification of incident hip fractures in large cohort studies: the study of osteoporotic fractures and medicare claims data. Osteoporos Int 24(3):801–10PubMedCentralPubMedCrossRef

47.

Chen Z, Kooperberg C, Pettinger MB et al (2004) Validity of self-report for fractures among a multi-ethnic cohort of postmenopausal women: results from the women’ health initiative observational study and clinical trials. Menopause 11(3):264–274PubMedCrossRef

48.

Trichopoulou A, Orfanos P, Norat T et al (2005) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330(7498):991

49.

Riboli E, Hunt KJ, Slimani N. (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5(6B):1113–1124

50.

Gao L, Weck MN, Michel A, Pawlita M, Brenner H. (2009) Association between chronic atrophic gastritis and serum antibodies to 15 Helicobacter pylori proteins measured by multiple serology. Cancer Res 69(7):2973–2980

51.

Schöttker, Müller H, Rothenbacher D, Brenner H. (2013) Fasting plasma glucose and HbA1c in cardiovascular risk prediction: a sex-specific comparison in individuals without diabetes mellitus. Diabetologia 56(1):92–100

52.

Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. (2012) Cohort profile: The Tromsø Study. Int J Epidemiol 41(4):961–967

53.

Ahmed LA, Schirmer H, Bjørnerem A et al (2009).The genderand age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol 24(8):441–448

54.

Ahmed LA, Center JR, Bjørnerem A et al (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsø study. J Bone Miner Res 28(10):2214–2221

55.

56.

Boffetta P, Bobak M, Borsch-Supan A, et al (2014) The Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES) project-design, population and data harmonization of a large-scale, international study. Eur J Epidemiol. 29(12):929–36

57.

Colditz GA, Hankinson SE (2005) The Nurses’ Health Study: lifestyle and health among women. Nat Rev Cancer 5(5):388–396

Titel: Education, marital status, and risk of hip fractures in older men and women: the CHANCES project
verfasst von: V. Benetou
P. Orfanos
D. Feskanich
K. Michaëlsson
U. Pettersson-Kymmer
L. A. Ahmed
A. Peasey
A. Wolk
H. Brenner
M. Bobak
T. Wilsgaard
B. Schöttker
K.-U. Saum
A. Bellavia
F. Grodstein
E. Klinaki
E. Valanou
E.-M. Papatesta
P. Boffetta
A. Trichopoulou
Publikationsdatum: 01.06.2015
Verlag: Springer London
Erschienen in: Osteoporosis International / Ausgabe 6/2015
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3054-9

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Education, marital status, and risk of hip fractures in older men and women: the CHANCES project

Abstract

Summary

Introduction

Methods

Results

Conclusions

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Zwei neue Alternativen zu TNF-Inhibitoren bei axSpA

Update Orthopädie und Unfallchirurgie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Summary

Introduction

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2015

Changes in quality of life associated with fragility fractures: Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS)

Atypical femur fracture during bisphosphonate drug holiday: a case series

Trabecular bone score may improve FRAX® prediction accuracy for major osteoporotic fractures in elderly Japanese men: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study

Peripheral quantitative computed tomography (pQCT) reveals low bone mineral density in adolescents with motor difficulties

Bone marrow fat is increased in chronic kidney disease by magnetic resonance spectroscopy

Platelet indices can relate to bone mineralization: response to comments by Varol

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Zwei neue Alternativen zu TNF-Inhibitoren bei axSpA

Update Orthopädie und Unfallchirurgie