Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study
Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study
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DOI：
10.1007/s00198-016-3853-7
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发表时间：
2017-04-01
影响因子：
4
通讯作者：
Johnsen, S. P.
中科院分区：
文献类型：
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作者：
Kristensen, P. K.;Thillemann, T. M.;Johnsen, S. P.
关于髋部骨折患者的社会经济状况与临床结局之间的关系，证据有限。在这项全国性的、基于人群的队列研究中，高等教育和较高的家庭收入与髋部骨折后30天死亡率和计划外再入院风险显著降低相关。我们研究了髋部骨折患者的社会经济地位与30天死亡率、急性再入院率、住院护理质量、手术时间和住院时间之间的关系。这是一项全国性的、一项基于人群的队列研究，使用丹麦多学科髋部骨折登记处前瞻性收集的数据。我们确定了2010年至2013年在丹麦医院收治的25，354例年龄65岁的髋部骨折患者。个人社会经济地位包括最高学历、家庭平均收入、同居状况和移民状况。我们进行了多水平回归分析，控制了潜在的混杂因素。与低教育程度的患者相比，受过高等教育的髋部骨折患者的30天死亡风险较低（7.3 vs 10.0%调整后比值比（OR）= 0.74（95%置信区间（CI）（0.63-0.88））。家庭收入最高的患者30天死亡率也较低（11.9% vs 13.0%调整后OR = 0.77，95%CI 0.69-0.85）。在校正分析中，同居状态和移民状态与30天死亡率无关。此外，高教育和高收入的患者急性再入院的风险较低（14.5 vs 16.9%调整OR = 0.94，95%CI 0.91-0.97）。然而，社会经济地位与住院治疗质量、手术时间和住院时间无关，而较高的教育程度和较高的家庭收入与髋部骨折后30天死亡率和再入院风险显著降低相关。
The evidence is limited regarding the association between socioeconomic status and the clinical outcome among patients with hip fracture. In this nationwide, population-based cohort study, higher education and higher family income were associated with a substantially lower 30-day mortality and risk of unplanned readmission after hip fracture.We examined the association between socioeconomic status and 30-day mortality, acute readmission, quality of in-hospital care, time to surgery and length of hospital stay among patients with hip fracture.This is a nationwide, population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. We identified 25,354 patients ae 65 years admitted with a hip fracture between 2010 and 2013 at Danish hospitals. Individual-level socioeconomic status included highest obtained education, family mean income, cohabiting status and migrant status. We performed multilevel regression analysis, controlling for potential confounders.Hip fracture patients with higher education had a lower 30-day mortality risk compared to patients with low education (7.3 vs 10.0% adjusted odds ratio (OR) = 0.74 (95% confidence interval (CI) (0.63-0.88)). The highest level of family income was also associated with lower 30-day mortality (11.9 vs 13.0% adjusted OR = 0.77, 95% CI 0.69-0.85). Cohabiting status and migrant status were not associated with 30-day mortality in the adjusted analysis. Furthermore, patients with both high education and high income had a lower risk of acute readmission (14.5 vs 16.9% adjusted OR = 0.94, 95% CI 0.91-0.97). Socioeconomic status was, however, not associated with quality of in-hospital care, time to surgery and length of hospital stay.Higher education and higher family income were associated with substantially lower 30-day mortality and risk of readmission after hip fracture.