title: Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study.
abstract: OBJECTIVE
  To determine the association between socioeconomic deprivation (SES) and hip fracture risk.
  
  
  METHODS
  Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area.
  
  
  METHODS
  a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data.
  
  
  RESULTS
  incident hip fracture rates as coded in medical records using ICD-10 codes.
  
  
  METHODS
  zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption.
  
  
  RESULTS
  Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference.
  
  
  CONCLUSIONS
  Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk.
authors.affiliation: Primary Health Care Center Eap Sardenya, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya 466, Barcelona 08025, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.
authors.forename: Carlen
authors.initials: C
authors.lastname: Reyes
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: García-Gil
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Elorza
authors.affiliation: Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Fina-Avilés
authors.affiliation: Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mendez-Boo
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hermosilla
authors.affiliation: Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.
authors.forename: Ermengol
authors.initials: E
authors.lastname: Coma
authors.affiliation: Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Carbonell
authors.affiliation: Primary Care Services Information System, Catalan Health Institute (ICS), Gran Via Corts Catalanes 587, Barcelona 08007, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Medina-Peralta
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Maluquer Salvador 11, Girona 17002, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit 77, Girona 17003, Spain; Primary Care Services, Girona, Catalan Institute of Health (ICS), Maluquer Salvador 11, Girona 17003, Spain.
authors.forename: Rafel
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Bolibar
authors.affiliation: Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Díez-Pérez
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jorid Gol), Gran Vía Corts Catalanes 587, 08007 Barcelona, Spain. Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Musculoskeletal Research Unit and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Doctor Aiguader 88, Barcelona 08003, Spain; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7HE, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Prieto-Alhambra
mesh_terms: D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class
keywords: Epidemiologic research design; Hip fracture; Osteoporosis; Social class