title: Age-period-cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk.
abstract: An age-period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000-2008). Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect).
  
  
  BACKGROUND
  Healthcare improvements have allowed prevention but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000-2008.
  
  
  METHODS
  From the National Hospital Discharge Register, we selected admissions (aged ≥ 49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages, we used an age-period-cohort model (1-year intervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures.
  
  
  RESULTS
  There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increasing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable-increasing), 1940 (decreasing-increasing) and 1950 (increasing-decreasing only among women).
  
  
  CONCLUSIONS
  Hip fracture risk was higher for those born during major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.
authors: Instituto de Engenharia Biomédica (INEB), Rua do Campo Alegre, 823, 4150-180, Porto, Portugal, smfa@ineb.up.pt.
authors: S Maria
authors: SM
authors: Alves
authors: D
authors: D
authors: Castiglione
authors: C Maria
authors: CM
authors: Oliveira
authors: B
authors: B
authors: de Sousa
authors: M Fátima
authors: MF
authors: Pina
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015988:Cohort Effect; D005260:Female; D006620:Hip Fractures / Q000191:economics / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D011057:Politics; D011174:Portugal / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D017678:Sex Distribution; D012959:Socioeconomic Factors
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