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30.08.2019 | Review

Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies

verfasst von: G. Valentin, S. E. Pedersen, R. Christensen, K. Friis, C. P. Nielsen, A. Bhimjiyani, C. L. Gregson, B. L. Langdahl

Erschienen in: Osteoporosis International | Ausgabe 1/2020

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

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Titel: Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies
verfasst von: G. Valentin
S. E. Pedersen
R. Christensen
K. Friis
C. P. Nielsen
A. Bhimjiyani
C. L. Gregson
B. L. Langdahl
Publikationsdatum: 30.08.2019
Verlag: Springer London
Erschienen in: Osteoporosis International / Ausgabe 1/2020
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-05143-y

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