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

In: Valentin , G , Pedersen , S E , Christensen , R , Friis , K , Nielsen , C P , Bhimjiyani , A , Gregson , C L & Langdahl , B L 2020 , ' Socio-economic inequalities in fragility fracture outcomes : a systematic review and meta-analysis of prognostic observational studies ' , Osteoporosis International , vol. 31 , no. 1 , pp. 31-42 . https://doi.org/10.1007/s00198-019-05143-y

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.