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Age–period–cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk

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Abstract

Summary

An age–period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000–2008). Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect).

Introduction

Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000–2008.

Methods

From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age–period–cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures.

Results

There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable–increasing), 1940 (decreasing–increasing) and 1950 (increasing–decreasing only among women).

Conclusions

Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.

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Acknowledgments

This work was supported by FEDER funds through the Programa Operacional Factores de Competitividade (COMPETE) and by Portuguese funds through Fundação para a Ciência e a Tecnologia (FCT) within the framework of the project PEst-C/SAU/LA0002/2011 and by PTDC/SAU-EPI/113424/2009 grant and SFRH/BD/40978/2007 fellowship.

We like to acknowledge the Central Administration of Health Services (ACSS) for the data from the National Hospital Discharge Register. We also like to acknowledge Paulo Nossa for helping with the understanding of economic, social and political history of Portugal.

Conflict of Interests

None.

Author information

Authors and Affiliations

  1. Instituto de Engenharia Biomédica (INEB), Rua do Campo Alegre, 823, 4150-180, Porto, Portugal

    S. Maria Alves, C. Maria Oliveira & M. Fátima Pina

  2. Escola Superior de Tecnologia da Saúde do Porto (ESTSP/IPP), Rua Valente Perfeito, 322, 4400-330, Vila Nova de Gaia, Portugal

    S. Maria Alves

  3. Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas 135, 4050-600, Porto, Portugal

    S. Maria Alves, C. Maria Oliveira & M. Fátima Pina

  4. Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz–FIOCRUZ, Rua Leopoldo Bulhões, 1480, 21041-210, Manguinhos, Rio de Janeiro, Brazil

    D. Castiglione

  5. Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal

    B. de Sousa

  6. Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental (CINEICC), Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal

    B. de Sousa

  7. Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    M. Fátima Pina

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  1. S. Maria Alves
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  2. D. Castiglione
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  3. C. Maria Oliveira
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  4. B. de Sousa
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  5. M. Fátima Pina
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Correspondence to S. Maria Alves.

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Alves, S.M., Castiglione, D., Oliveira, C.M. et al. Age–period–cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk. Osteoporos Int 25, 711–720 (2014). https://doi.org/10.1007/s00198-013-2483-6

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  • DOI: https://doi.org/10.1007/s00198-013-2483-6

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