title: Education, marital status, and risk of hip fractures in older men and women: the CHANCES project.
abstract: The role of socioeconomic status in hip fracture incidence is unclear. In a diverse population of elderly, higher education was found to be associated with lower, whereas living alone, compared to being married/cohabiting, with higher hip fracture risk. Educational level and marital status may contribute to hip fracture risk.
  
  
  BACKGROUND
  The evidence on the association between socioeconomic status and hip fracture incidence is limited and inconsistent. We investigated the potential association of education and marital status with hip fracture incidence in older individuals from Europe and USA.
  
  
  METHODS
  A total of 155,940 participants (79 % women) aged 60 years and older from seven cohorts were followed up accumulating 6456 incident hip fractures. Information on education and marital status was harmonized across cohorts. Hip fractures were ascertained through telephone interviews/questionnaires or through record linkage with registries. Associations were assessed through Cox proportional hazard regression adjusting for several factors. Summary estimates were derived using random effects models.
  
  
  RESULTS
  Individuals with higher education, compared to those with low education, had lower hip fracture risk [hazard ratio (HR) = 0.84, 95 % confidence interval (CI) 0.72-0.95]. Respective HRs were 0.97 (95 % CI 0.82-1.13) for men and 0.75 (95 % CI 0.65-0.85) for women. Overall, individuals living alone, especially those aged 60-69 years, compared to those being married/cohabiting, tended to have a higher hip fracture risk (HR = 1.12, 95 % CI 1.02-1.22). There was no suggestion for heterogeneity across cohorts (P heterogeneity > 0.05).
  
  
  CONCLUSIONS
  The combined data from >150,000 individuals 60 years and older suggest that higher education may contribute to lower hip fracture risk. Furthermore, this risk may be higher among individuals living alone, especially among the age group 60-69 years, when compared to those being married/cohabiting.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece. vbenetou@med.uoa.gr.|Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece. vbenetou@med.uoa.gr.
authors.forename: V
authors.initials: V
authors.lastname: Benetou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.|Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Orfanos
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Feskanich
authors.affiliation: Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Michaëlsson
authors.affiliation: Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Pettersson-Kymmer
authors.affiliation: Department of Health and Care Sciences, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.|Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: L A
authors.initials: LA
authors.lastname: Ahmed
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Peasey
authors.affiliation: Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wolk
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Bobak
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schöttker
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: K-U
authors.initials: KU
authors.lastname: Saum
authors.affiliation: Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Bellavia
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Grodstein
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Klinaki
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Valanou
authors.affiliation: Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.
authors.forename: E-M
authors.initials: EM
authors.lastname: Papatesta
authors.affiliation: Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.|Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: P
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, 75 Mikras Asias Str, Athens, 115 27, Greece.|Hellenic Health Foundation, Kaisareias 13 and Alexandroupoleos Str, Athens, 115 27, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Education; Elderly; Fractures; Hip fractures; Marital status; Socioeconomic status
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