The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study.
We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients.



To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors.



We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group.



Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size.



We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.
Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK. k.thorne@swansea.ac.uk.
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Thorne
Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.|Trauma Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
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Johansen
Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
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Akbari
Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
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Williams
Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
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Roberts
D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012934:Social Isolation; D012959:Socioeconomic Factors; D014852:Wales
Hip fracture; Mortality; Risk factors; Social deprivation