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Social inequality and fractures—secular trends in the Danish population: a case-control study

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Abstract

Summary

We examined links between markers of social inequality and fracture risk in the Danish population, demonstrating that high income and being married are associated with a significantly lower risk.

Introduction

We explored whether the risk of hip, humerus, and wrist fracture was associated with markers of inequality using data from Danish health registries.

Methods

All patients 50 years or older with a primary hip (ICD10 S720, S721, S722, and S729) humerus (ICD10 S422, S423, S424, S425, S426, and S427), or wrist (ICD10: S52) fracture were identified from 1/1/1995 to 31/12/2011. Fracture patients were matched 1:1 by age, sex, and year of fracture, to a non-fracture control. Markers of inequality were as follows: income (fifths); marital status (married, divorced, widowed, or unmarried); area of residence (remote, rural, intermediate, or urban). Conditional logistic regression was used to investigate associations between these exposures, and risk of fracture, adjusting for covariates (smoking, alcohol, and Charlson co-morbidity). Interactions were fitted between exposure and covariates where appropriate.

Results

A total of 189,838 fracture patients (37,500 hip, 45,602 humerus, and 106,736 wrist) and 189,838 controls were included. Mean age was 73.9 years (hip), 67.5 years (humerus), and 65.3 years (wrist). High income (5th quintile) was significantly associated with a lower odds ratio of all three fractures, compared to average income (3rd quintile). Married subjects had a significantly decreased odds ratio across all three fractures. However, no overall secular difference was observed regarding the influence of the markers of inequality.

Conclusion

In conclusion, we have demonstrated important, stable associations between social inequality, assessed using income, marital status, and area of residence, and fracture at the population level. These findings can inform approaches to healthcare, and suggest that much thought should be given to novel interventions aimed especially at those living alone, and ideally societal measures to reduce social inequality.

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Author information

Author notes

  1. Bo Abrahamsen and Nicholas C Harvey are joint senior authors

Authors and Affiliations

  1. Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark

    L. Hansen

  2. University of Bristol, Bristol, England

    A. Judge

  3. NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK

    M.K. Javaid & C. Cooper

  4. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK

    C. Cooper & N.C. Harvey

  5. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK

    C. Cooper & N.C. Harvey

  6. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    P. Vestergaard

  7. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    P. Vestergaard

  8. Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    B. Abrahamsen

  9. Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark

    B. Abrahamsen

  10. Odense Exploratory Patient Network (OPEN), University of Southern Denmark and Odense University Hospital, Odense, Denmark

    B. Abrahamsen

Authors
  1. L. Hansen
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  2. A. Judge
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  3. M.K. Javaid
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  4. C. Cooper
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  5. P. Vestergaard
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  6. B. Abrahamsen
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  7. N.C. Harvey
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Corresponding author

Correspondence to N.C. Harvey.

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Conflicts of interest

Louise Hansen, Andrew Judge, M Kassim Javaid, Cyrus Cooper, Peter Vestergaard, and Nicholas C Harvey declare that they have no conflicts of interest. Bo Abrahamsen has institutional research grants from UCB and Novartis with funds paid to the institution.

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Hansen, L., Judge, A., Javaid, M. et al. Social inequality and fractures—secular trends in the Danish population: a case-control study. Osteoporos Int 29, 2243–2250 (2018). https://doi.org/10.1007/s00198-018-4603-9

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  • DOI: https://doi.org/10.1007/s00198-018-4603-9

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