Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture.
OBJECTIVE
In countries where the National Health Service provides universal health coverage, socioeconomic position should not influence the quality of health care. We examined whether socioeconomic position plays a role in short-term mortality and waiting time for surgery after hip fracture.


METHODS
Retrospective cohort study.


METHODS
and participants From the Hospital Information System database, we selected all patients, aged at least 65 years and admitted to acute care hospitals in Rome for a hip fracture between 1 January 2006 and 30 November 2007. The socioeconomic position of each individual was obtained using a city-specific index of socioeconomic variables based on the individual's census tract of residence.


METHODS
Three different outcomes were defined: waiting times for surgery, mortality within 30 days and intervention within 48 h of hospital arrival for hip fracture. We used a logistic regression to estimate 30-day mortality and a Cox proportional hazard model to calculate hazard ratios of intervention within 48 h. Median waiting times were estimated by adjusted Kaplan-Meyer curves. Analyses were adjusted for age, gender and coexisting medical conditions.


RESULTS
Low socioeconomic level was significantly associated with higher risk of mortality [adjusted relative risk (RR) = 1.51; P < 0.05] and lower risk of early intervention (adjusted RR = 0.32; P < 0.001). Socioeconomic level had also an effect on waiting times within 30 days.


CONCLUSIONS
Individuals living in disadvantaged census tracts had poorer prognoses and were less likely than more affluent people to be treated according to clinical guidelines despite universal healthcare coverage.
Barone
Anna Patrizia
AP
Department of Epidemiology, Local Health Authority RME, Via di S. Costanza, 53, Rome 00198, Italy. barone@asplazio.it
Fusco
Danilo
D
Colais
Paola
P
D'Ovidio
Mariangela
M
Belleudi
Valeria
V
Agabiti
Nera
N
Sorge
Chiara
C
Davoli
Marina
M
Perucci
Carlo Alberto
CA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D006620:Hip Fractures / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012384:Rome / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014850:Waiting Lists