title: Socioeconomic inequality in clinical outcome among hip fracture patients: a nationwide cohort study.
abstract: The evidence is limited regarding the association between socioeconomic status and the clinical outcome among patients with hip fracture. In this nationwide, population-based cohort study, higher education and higher family income were associated with a substantially lower 30-day mortality and risk of unplanned readmission after hip fracture.
  
  
  
  We examined the association between socioeconomic status and 30-day mortality, acute readmission, quality of in-hospital care, time to surgery and length of hospital stay among patients with hip fracture.
  
  
  
  This is a nationwide, population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. We identified 25,354 patients ≥65 years admitted with a hip fracture between 2010 and 2013 at Danish hospitals. Individual-level socioeconomic status included highest obtained education, family mean income, cohabiting status and migrant status. We performed multilevel regression analysis, controlling for potential confounders.
  
  
  
  Hip fracture patients with higher education had a lower 30-day mortality risk compared to patients with low education (7.3 vs 10.0% adjusted odds ratio (OR) = 0.74 (95% confidence interval (CI) (0.63-0.88)). The highest level of family income was also associated with lower 30-day mortality (11.9 vs 13.0% adjusted OR = 0.77, 95% CI 0.69-0.85). Cohabiting status and migrant status were not associated with 30-day mortality in the adjusted analysis. Furthermore, patients with both high education and high income had a lower risk of acute readmission (14.5 vs 16.9% adjusted OR = 0.94, 95% CI 0.91-0.97). Socioeconomic status was, however, not associated with quality of in-hospital care, time to surgery and length of hospital stay.
  
  
  
  Higher education and higher family income were associated with substantially lower 30-day mortality and risk of readmission after hip fracture.
authors.affiliation: Department of Orthopedic Surgery, Horsens Hospital, Sundvej 30, 8700, Horsens, Denmark. pia.kjar.kristensen@horsens.rm.dk.|Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark. pia.kjar.kristensen@horsens.rm.dk.
authors.forename: P K
authors.initials: PK
authors.lastname: Kristensen
authors.affiliation: Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8200, Aarhus, Denmark.
authors.forename: T M
authors.initials: TM
authors.lastname: Thillemann
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
authors.forename: A B
authors.initials: AB
authors.lastname: Pedersen
authors.affiliation: Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8200, Aarhus, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Søballe
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
authors.forename: S P
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005593:Fracture Fixation, Internal / Q000401:mortality; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: 30-day mortality; Hip fracture; Length of stay; Patient readmission; Quality of health care; Social class