title: Socioeconomic status in relation to incident fracture risk in the Study of Women's Health Across the Nation.
abstract: We examined baseline and annual follow-up data (through annual follow-up visit 9) from a cohort of 2,234 women aged 42 to 52 years at baseline. Independent of financial status, higher educational level was associated with lower fracture incidence among non-Caucasian women but not among Caucasian women.
  
  
  BACKGROUND
  This study was conducted to determine the associations of education and income with fracture incidence among midlife women over 9 years of follow-up.
  
  
  METHODS
  We examined baseline and annual follow-up data (through annual follow-up visit 9) from 2,234 participants of the Study of Women's Health Across the Nation, a cohort of women aged 42 to 52 years at baseline. We used Cox proportional hazards regression models to examine the associations of socioeconomic predictors (education, family-adjusted poverty-to-income ratio, and difficulty paying for basics) with time to first incident nontraumatic, nondigital, noncraniofacial fracture.
  
  
  RESULTS
  Independent of family-adjusted poverty-to-income ratio, higher educational level was associated with decreased time to first incident fracture among non-Caucasian women but not among Caucasian women (p(interaction) 0.02). Compared with non-Caucasian women who completed no more than high school education, non-Caucasian women who attained at least some postgraduate education had 87% lower rates of incident nontraumatic fracture (adjusted hazard ratio 0.13, 95% confidence interval [CI] 0.03-0.60). Among non-Caucasian women, each additional year of education was associated with a 16% lower odds of nontraumatic fracture (adjusted odds ratio 0.84, 95% CI 0.73-0.97). Income, family-adjusted poverty-to-income ratio, and degree of difficulty paying for basic needs were not associated with time to first fracture in Caucasian or non-Caucasian women.
  
  
  CONCLUSIONS
  Among non-Caucasian midlife women, higher education, but not higher income, was associated with lower fracture incidence. Elucidation of the mechanisms underlying the possible protective effects of higher educational level on nontraumatic fracture incidence may allow us to better target individuals at risk of future fracture.
authors: Division of General Internal Medicine, David Geffen School of Medicine at University of California, 911 Broxton Ave., 1st floor, Los Angeles, CA, 90024, USA, ccrandall@mednet.ucla.edu.
authors: C J
authors: CJ
authors: Crandall
authors: W
authors: W
authors: Han
authors: G A
authors: GA
authors: Greendale
authors: T
authors: T
authors: Seeman
authors: P
authors: P
authors: Tepper
authors: R
authors: R
authors: Thurston
authors: C
authors: C
authors: Karvonen-Gutierrez
authors: A S
authors: AS
authors: Karlamangla
mesh_terms: D000328:Adult; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008593:Menopause / Q000208:ethnology / Q000502:physiology; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000208:ethnology* / Q000209:etiology; D011203:Poverty / Q000706:statistics & numerical data; D012307:Risk Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D016387:Women's Health / Q000706:statistics & numerical data