Oral Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Widening gap: low socioeconomic status as a risk factor for increased post-fracture excess mortality (#232)

Thach Tran 1 2 , Dana Bliuc 2 , Bo Abrahamsen 3 4 , Weiwen Chen 2 , Louise Hansen 5 , Peter Vestergaard 6 7 , Robert D Blank 2 , Jacqueline R Center 2 8 9 , Tuan V Nguyen 1 10
  1. School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
  2. Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
  3. Department of Medicine, Holbak Hospital, Holbak , Denmark
  4. Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
  5. Kontraktenheden, North Denmark Region, Aalborg, Denmark
  6. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  7. Steno Diabetes Center , North Jutland, Denmark
  8. School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
  9. Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
  10. School of Population Health, UNSW Sydney, Sydney, NSW, Australia

The impact of socioeconomic differences to all-cause mortality has been observed worldwide, but their contribution to post-fracture mortality remains unclear. We sought to investigate the association between socioeconomic disparity and excess deaths following a fracture.

This nationwide population-based cohort study involved 95,372 men and 212,498 women with an incident fracture in Denmark at an average age of 72 and 75 years, respectively, between 2001 and 2014. Fracture was identified using ICD-10 codes from the Danish National Hospital Discharge Register. Both individual-based socioeconomic measures (i.e., personal income, educational attainment, occupation or marital status) and area-based measures (i.e., residential area) closest to the fracture time were considered. Relative survival analysis was used to quantify excess mortality attributable to the combination of socioeconomic disparity and individual fracture sites, accounting for the confounding effects of sex, aging, time-related mortality changes in the general population and comorbidities.

During a median follow-up of 6.5 years (IQR: 3-11), 41,017 men and 81,727 women died post-fracture. We found a dose-response relationship between all individual-based SES measures, but not residential area, and post-fracture excess mortality across sexes. Importantly, the combination of socioeconomic disparity and proximal fractures (i.e., hip, femur, pelvis, vertebrae, humerus, rib, clavicle) compounded the association with excess mortality, conferring much greater mortality risk than either alone. For example, the 1-year excess mortality for men in the poorest income quintile with a hip fracture was 33.1% (95% CI: 31.7%-34.5%), significantly greater than excess mortality among men in the richest income quintile with a hip fracture (15.4%; 13.9%-16.9%) or men in the poorest income quintile with a hand fracture (2.0%; 0.5%-3.8%) (Figure).

The findings underscore the significant role that socioeconomic disparity contributes to post-fracture excess mortality, highlighting the need for population-based preventive interventions to reduce socioeconomic discrepancies and better understand the determinants of socioeconomic disparity affecting post-fracture excess mortality.669cc18df0b09-Income_Excess+death+(resized).jpg