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

Rita Patel*, Arti G Bhimjiyani, Yoav Ben-Shlomo, Celia L Gregson

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
4 Downloads (Pure)

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.

Original languageEnglish
Pages (from-to)1129-1141
Number of pages13
JournalOsteoporosis International
Volume32
Issue number6
Early online date5 Jan 2021
DOIs
Publication statusPublished - 5 Jan 2021

Bibliographical note

Funding Information:
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.

Funding Information:
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.

Publisher Copyright:
© 2021, International Osteoporosis Foundation and National Osteoporosis Foundation.

Keywords

  • Epidemiology
  • Health inequality
  • IMD - index of multiple deprivation
  • Deprivation
  • Neck of femur
  • Health outcomes

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