Skip to main content

Advertisement

SpringerLink
Log in

Social deprivation predicts adverse health outcomes after hospital admission with hip fracture in England

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We found social deprivation to be associated with higher mortality in the year following hip fracture among men and women aged 60 years and older in England. In those who did survive, deprivation was associated with longer hospital stays and greater risk of subsequent emergency readmission particularly for patients with dementia.

Introduction

Social deprivation predicts a range of adverse health outcomes; however, its impact on outcomes following hip fracture is not established. We examined the effect of area-level social deprivation on outcomes following hospital admission for hip fracture in England.

Methods

We used English Hospital Episodes Statistics linked to the National Hip Fracture Database (April 2011–March 2015) and Office for National Statistics mortality database, to identify patients aged 60+ years admitted with hip fracture. Deprivation was measured using Index of Multiple Deprivation quintiles; Q1-least deprived; Q5-most deprived, and outcomes by mortality over 1-year, length-of-stay in NHS acute and rehabilitation hospitals (‘superspell’), and emergency 30-day readmission.

Results

We identified 218,907 admissions with an index hip fracture (mean age 82.8 [standard deviation, SD 8.4] years; 72.6% female). Each quintile of deprivation was associated with greater mortality; age-adjusted 30-day mortality odds ratio, OR 1.30 [95% confidence interval, CI: 1.24, 1.37], p < 0.001, equating to on average 1038 fewer deaths/year among those who are least deprived (Q1 versus 2–5). Similarly, at 365 days, those most deprived had 24% higher mortality (age-sex-comorbidity-adjusted OR:1.24 [1.20, 1.28], p < 0.001; Q5 versus Q1). Among survivors, mean superspell was longer in the most versus least deprived (Q5:24.4 [SD 21.7] days, Q1:23.3 [SD 22.1], p < 0.001). Readmission was more common in those most versus least deprived (age-sex-comorbidity-adjusted OR 1.27 [1.22, 1.32], p < 0.001).

Conclusion

Greater deprivation is associated with reduced survival at all timepoints in the year following hip fracture. Among survivors, hospital stay is increased as is readmission risk. The extent to which configuration of English hospital services, rather than patient case-mix, explains these apparent health inequalities remains to be determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Judge A, Javaid K, Cooper C, Arden N, Farmer A, Prieto-Alhambra D, et al (2016) Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within the South Central Region. National Institute for Health Research (NIHR), Health Services and Delivery Research (HS&DR)

  2. Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML (2015) Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation--a prospective cohort study. Bone Joint J 97–b(3):372–382. https://doi.org/10.1302/0301-620x.97b3.35738

  3. Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate at 1-year post hip fracture-a systematic review. World J Orthop 10(3):166–175

  4. Bai J, Zhang P, Liang X, Wu Z, Wang J, Liang Y (2018) Association between dementia and mortality in the elderly patients undergoing hip fracture surgery: a meta-analysis. J Orthop Surg Res 13(1):298. https://doi.org/10.1186/s13018-018-0988-6

  5. Royal College of Physicians (2016) National Hip Fracture Database annual report 2016. London: RCP

  6. The NHS Information Centre (2013) Emergency readmissions 2010–11 summary. Department of Health, https://www.gov.uk/government/publications/emergency-readmissions-data

  7. Ali AM, Gibbons CE (2017) Predictors of 30-day hospital readmission after hip fracture: a systematic review. Injury 48(2):243–252

    Article  Google Scholar 

  8. Lang IA, Hubbard RE, Andrew MK, Llewellyn DJ, Melzer D, Rockwood K (2009) Neighborhood deprivation, individual socioeconomic status, and frailty in older adults. J Am Geriatr Soc 57(10):1776–1780

    Article  Google Scholar 

  9. Pujades-Rodriguez M, Timmis A, Stogiannis D, Rapsomaniki E, Denaxas S, Shah A, Feder G, Kivimaki M, Hemingway H (2014) Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention. PLoS One 9(8):e104671

    Article  Google Scholar 

  10. Lee TC, Glynn RJ, Peña JM, Paynter NP, Conen D, Ridker PM, Pradhan AD, Buring JE, Albert MA (2011) Socioeconomic status and incident type 2 diabetes mellitus: data from the Women’s Health Study. PLoS One 6(12):e27670

    Article  CAS  Google Scholar 

  11. Riaz SP, Horton M, Kang J, Mak V, Lüchtenborg M, Møller H (2011) Lung cancer incidence and survival in England: an analysis by socioeconomic deprivation and urbanization. J Thorac Oncol 6(12):2005–2010

    Article  Google Scholar 

  12. van de Vorst IE, Koek HL, Stein CE, Bots ML, Vaartjes I (2016) Socioeconomic disparities and mortality after a diagnosis of dementia: results from a nationwide registry linkage study. Am J Epidemiol 184(3):219–226. https://doi.org/10.1093/aje/kwv319

    Article  PubMed  Google Scholar 

  13. Bhimjiyani A, Neuburger J, Jones T, Ben-Shlomo Y, Gregson CL (2018) The effect of social deprivation on hip fracture incidence in England has not changed over 14 years: an analysis of the English Hospital Episodes Statistics (2001-2015). Osteoporos Int 29(1):115–124. https://doi.org/10.1007/s00198-017-4238-2

    Article  CAS  PubMed  Google Scholar 

  14. Valentin G, Pedersen SE, Christensen R, Friis K, Nielsen CP, Bhimjiyani A, Gregson CL, Langdahl BL (2020) Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies. Osteoporos Int 31(1):31–42. https://doi.org/10.1007/s00198-019-05143-y

    Article  CAS  PubMed  Google Scholar 

  15. Smith P, Ariti C, Bardsley M (2013) Focus on hip fracture: trends in emergency admissions for fractured neck of femur, 2001 to 2011. QualityWatch. The Health Foundation and Nuffield Trust, London

  16. Kristensen PK, Thillemann TM, Pedersen AB, Soballe K, Johnsen SP (2017) Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study. Osteoporos Int 28(4):1233–1243

    Article  CAS  Google Scholar 

  17. Gaughan J, Gravelle H, Santos R, Siciliani L (2017) Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients. International journal of health economics and management 17(3):311–331

    Article  Google Scholar 

  18. 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):801–805

    Article  CAS  Google Scholar 

  19. Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD (2015) The determinants of costs and length of stay for hip fracture patients. PLoS One 10(7):e0133545

    Article  Google Scholar 

  20. Holder H, Kumpunen S, Castle-Clarke S, Lombardo S (2018) Managing the hospital and social care interface. Interventions targeting older adults. The Nuffield Trust

  21. Bunning T, Dickinson R, Fagan E, Inman D, Johansen A, Judge A, Hannaford J, Liddicoat M, Wakeman R (2017) National Hip Fracture Database (NHFD) Annual Report 2018. Royal College of Physicians: London, UK

  22. Bhimjiyani A (2019) Social and regional inequalities in the incidence of and outcomes after hip fracture in England. Dept Translational Health Sciences University of Bristol, Bristol Medical School Thesis Repository

  23. Health and Social Care Information Centre (2017) HES Data Dictionary: Admitted Patient Care

  24. NHS Digital (2018) Linked HES-ONS mortality data. https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/linked-hes-ons-mortality-data. Accessed 25/05/2018

  25. Department for Communities and Local Government (2011) The English indices of deprivation 2010: Technical Report

  26. McLennan D, Barnes H, Noble M, Davies J, Garratt E, Dibben C (2011) The english indices of deprivation 2010. Department for communities and local government. Her Majesty’s Stationery Office, London

  27. Armitage JN, van der Meulen JH (2010) Identifying co-morbidity in surgical patients using administrative data with the Royal College of Surgeons Charlson score. Br J Surg 97(5):772–781. https://doi.org/10.1002/bjs.6930

    Article  CAS  PubMed  Google Scholar 

  28. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology: The Journal of the American Society of Anesthesiologists 2(3):281–284

    Article  Google Scholar 

  29. Royal College of Physicians (2018) National Hip Fracture Database (NHFD) Website user guide V 11.0. London: RCP

  30. Barone AP, Fusco D, Colais P, D'Ovidio M, Belleudi V, Agabiti N, Sorge C, Davoli M, Perucci CA (2009) Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture. Int J Qual Health Care 21(6):379–386

    Article  Google Scholar 

  31. Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE (2016) The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int 27(9):2727–2737

    Article  CAS  Google Scholar 

  32. Roberts SE, Goldacre MJ (2003) Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98: database study. BMJ 327(7418):771–775

    Article  Google Scholar 

  33. Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332(7547):947–951

    Article  Google Scholar 

  34. Wu TY, Jen MH, Bottle A, Liaw CK, Aylin P, Majeed A (2011) Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health 33(2):284–291

  35. Cookson R, Propper C, Asaria M, Raine R (2016) Socio-economic inequalities in health care in England. Fisc Stud 37(3–4):371–403. https://doi.org/10.1111/j.1475-5890.2016.12109

    Article  Google Scholar 

  36. Prince M, Knapp M, Guerchet M, McCrone P, Prina M, Comas-Herrera A, Wittenberg R, Adelaja B, Hu B, King D, Rehill A, Salimkumar D (2014) Dementia UK: update. Alzheimer’s Society

  37. Smith P, Sherlaw-Johnson C, Ariti C, Bardsley M (2015) Focus on: hospital admissions from care homes. The Health Foundation and Nuffield Trust, London

    Google Scholar 

  38. Office for National Statistics (2015) 2011 Census analysis: what does the 2011 census tell us about people living in communal establishments? https://www.ons.gov.uk/peoplepopulationandcommunity/housing/articles/2011censusanalysiswhatdoesthe2011censustellusaboutpeoplelivingincommunalestablishments/2015-02-11 (30/04/2019)

  39. Department for Communities and Local Government (2015) The English Indices of Deprivation 2015 Statistical Release

  40. Mudrazija S, Thomeer MB, Angel JL (2015) Gender differences in institutional long-term care transitions. Womens Health Issues 25(5):441–449. https://doi.org/10.1016/j.whi.2015.04.010

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kristensen PK, Johnsen SP, Mor A, Thillemann TM, Pedersen AB (2017) Is the higher mortality among men with hip fracture explained by sex-related differences in quality of in-hospital care? A population-based cohort study. Age Ageing 46(2):193–199

    Article  Google Scholar 

  42. Health and Social Care Information Centre (2013) Hospital episode statistics, emergency readmissions to hospital within 28 days of discharge - Financial year 2011/12

  43. French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ (2008) Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc 56(4):705–710

    Article  Google Scholar 

  44. Basques BA, Bohl DD, Golinvaux NS, Leslie MP, Baumgaertner MR, Grauer JN (2015) Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis of 8434 patients. J Orthop Trauma 29(3):e115–e120

    Article  Google Scholar 

  45. Kates SL, Shields E, Behrend C, Noyes KK (2015) Financial implications of hospital readmission after hip fracture. Geriatr Orthop Surg Rehabil 6(3):140–146

    Article  Google Scholar 

  46. Schrøder H, Petersen KK, Erlandsen M (1993) Occurrence and incidence of the second hip fracture. Clin Orthop Relat Res 289:166–169

    Google Scholar 

  47. Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res Off J Am Soc Bone Miner Res 24(7):1299–1307. https://doi.org/10.1359/jbmr.090207

    Article  Google Scholar 

  48. Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, Geddes I (2010) Fair society, healthy lives: strategic review of health inequalities in England post-2010. The Marmot Review 2010 February;Available from: http://www.marmotreview.org/

Download references

Acknowledgments

The authors acknowledge Jenny Neuburger for her considered comments to the manuscript. Susan Charman for access to the Stata code that she developed for calculating the Royal College of Surgeons Charlson score. We are grateful to NHS Digital, the Royal Collage of Physician’s Falls and Fragility Fracture Audit Programme, and the Office of National Statistics for providing the data used in this study and to Crown for extracting and supplying the data. The views expressed in this publication are those of the authors and do not necessarily reflect those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. This publication is based on data collected by or on behalf of the Healthcare Quality Improvement Partnership, who have no responsibility or liability for the accuracy, currency, reliability and/or correctness of this publication.

Funding

RP and CLG are supported by Versus Arthritis (ref. 22086). CLG was funded by Versus Arthritis (ref. 20000). AB was supported by the Linda Edwards Memorial PhD studentship funded by the Royal Osteoporosis Society. YBS’s time is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (ARC West) at University Hospitals Bristol NHS Foundation Trust.

Author information

Authors and Affiliations

  1. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    R. Patel & C. L. Gregson

  2. Department of Clinical Biochemistry, Royal Free Hospital, London, UK

    A. Bhimjiyani

  3. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    Y. Ben-Shlomo

Authors
  1. R. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Bhimjiyani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Ben-Shlomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. L. Gregson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Patel.

Ethics declarations

Conflict of interest

CLG chairs the Royal College of Physicians Falls and Fragility Fracture Audit Programme (FFFAP) Scientific and Publications committee (a voluntary position). RP, AB, and YBS declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 69.7 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, R., Bhimjiyani, A., Ben-Shlomo, Y. et al. Social deprivation predicts adverse health outcomes after hospital admission with hip fracture in England. Osteoporos Int 32, 1129–1141 (2021). https://doi.org/10.1007/s00198-020-05768-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05768-4

Keywords

Search

Navigation