title: Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000-2010) in Portugal: age and sex temporal trends in a population based study.
abstract: Socioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000-2010, by regional socioeconomic status (SES), sex and age.
  
  
  
  We selected registers of patients aged 50+ years with HF (International Classification of Diseases, V.9-Clinical Modification, ICD9-CM) caused by traumas of low/moderate energy, from the National Hospital Discharge Database. Annual time series of age-specific incidence rates were calculated by sex and regional SES (deprived, medium, affluent). Generalised additive models were fitted to identify shape/turning points in temporal trends.
  
  
  
  We selected 96 905 HF (77.3% in women). Women were older than men at admission (81.2±8.5 vs 78.2±10.1 years-old, p<0.001). For women 65-79 years, a continuously decreasing trend (1.7%/year) only in affluent and increasing trends (3.3-3.4%/year) after 2006/2007 in medium and deprived was observed. For men, trends were stable or increased in almost all age/SES groups (only two decreasing periods). For the oldest women, all SES present similar trends: turning points around 2003 (initiating decreasing periods: 1.8-2.9%/year) and around 2007 (initiating increasing periods: 3.7-3.3%/year).
  
  
  
  There were SES-sex-age inequalities in temporal trends during BJD-Portugal: marked SES inequalities among women aged 65-79 years (a persistent, decreasing trend only in the affluent) vanished among the oldest women; the same was not observed in men, for them, there were almost no declining periods; women aged ≥80 years, presented increasing trends around 2007, as in most deprived/age/sex groups. Despite some successful periods of decreasing trends, incidence rates did not improve overall in almost all age groups and both sexes.
authors.affiliation: i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal ESTSP/IPP-Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do Porto, Vila Nova de Gaia, Portugal FMUP-Faculdade de Medicina da Universidade do Porto, Porto, Portugal ISPUP-Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Oliveira
authors.affiliation: i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal ESTSP/IPP-Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do Porto, Vila Nova de Gaia, Portugal.
authors.forename: Sandra Maria
authors.initials: SM
authors.lastname: Alves
authors.affiliation: i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal FMUP-Faculdade de Medicina da Universidade do Porto, Porto, Portugal ICICT/FIOCRUZ-Instituto de Comunicação e Informação em Saúde/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil CARTO-FEN/UERJ-Departamento de Engenharia Cartográfica, Faculdade de Engenharia da Universidade do Estado do Rio de Janeiro. Rua São Francisco Xavier, Rio de Janeiro-RJ, Brazil.
authors.forename: Maria Fátima
authors.initials: MF
authors.lastname: Pina
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D054624:Health Status Disparities; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012042:Registries; D012959:Socioeconomic Factors
keywords: FRACTURES; MODELLING; OSTEOPOROSIS; SOCIAL INEQUALITIES; TIME-SERIES