title: Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study.
abstract: Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post-hip fracture mortality. Our objective was to investigate educational inequalities in post-hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register-based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post-hip fracture mortality in both sexes. Compared with those with primary education only, the age-adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77-0.87) in men and 0.79 (95% CI 0.75-0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1-year age-adjusted mortality was three- to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1-year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post-hip fracture mortality.
authors.affiliation: Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Tone K
authors.initials: TK
authors.lastname: Omsland
authors.affiliation: Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia.|Department of Endocrinology, St Vincent's Hospital, Sydney, Australia.|School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.|St. Vincent's Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Naess
authors.affiliation: Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia.|Department of Endocrinology, St Vincent's Hospital, Sydney, Australia.|St. Vincent's Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Center
authors.affiliation: Department of Rheumatology, Haukeland University Hospital, Bergen, Bergen, Norway.|Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Clara G
authors.initials: CG
authors.lastname: Gjesdal
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.affiliation: Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway.
authors.forename: Nina
authors.initials: N
authors.lastname: Emaus
authors.affiliation: Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Haakon E
authors.initials: HE
authors.lastname: Meyer
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Anne Johanne
authors.initials: AJ
authors.lastname: Søgaard
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Kristin
authors.initials: K
authors.lastname: Holvik
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.
authors.forename: Berit
authors.initials: B
authors.lastname: Schei
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Forsmo
authors.affiliation: Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jeanette H
authors.initials: JH
authors.lastname: Magnus
mesh_terms: D000368:Aged; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D012042:Registries; D012307:Risk Factors; D012923:Social Class
keywords: EDUCATION; HIP FRACTURE; MORTALITY; SOCIOECONOMY