title: Relationship between socioeconomic status and mortality after femur fracture in a Korean population aged 65 years and older: Nationwide retrospective cohort study.
abstract: Femur fracture is an emerging public health concern in aging societies, owing to the substantially high morbidity and mortality. Because the recent increase in femur fracture incidence in Asian populations is comparable to that in the West, it is necessary to investigate the association between socioeconomic status (SES) and mortality after femur fracture in developed Asian societies.Data were obtained from the National Health Insurance Claims Database. During 2002 to 2013, femur fractures were newly diagnosed in 5441 patients among 1025,340 enrollees. Multiple logistic regression and the Cox proportional model were used to investigate the associations between individual SES and probability of surgery and mortality after femur fracture.Of 5441 patients, 1928 (35.4%) received surgery. Patients with low (odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.75-0.99) and middle (OR = 0.85, 95% CI: 0.74-0.98) income were less likely to undergo surgery than high-income patients. Patients with low (hazard ratio [HR] = 1.12, 95% CI: 1.01-1.24) and middle (HR = 1.20, 95% CI: 1.08-1.33) income had a higher HR for mortality. This difference was more prominent in patients who underwent surgery (low income: HR = 1.07, 95% CI: 0.94-1.21; middle income: HR = 1.18, 95% CI: 1.04-1.33) than in patients with conservative treatment (low income: HR = 1.24, 95% CI: 1.04-1.49; middle income: HR = 1.30, 95% CI: 1.08-1.56).Femur-fracture patients with low SES are less likely to receive surgery for and more likely to die after femur fracture. The difference in mortality risk remained even when only the patients who received surgery were considered, suggesting that we need to consider support measures for these deprived patients.
authors.affiliation: Department of Preventive Medicine Institute of Health Services Research, Yonsei University College of Medicine Department of Public Health, Graduate School Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea.
authors.forename: Jaeyong
authors.initials: J
authors.lastname: Shin
authors.forename: Young
authors.initials: Y
authors.lastname: Choi
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Woorim
authors.initials: W
authors.lastname: Kim
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D000072700:Conservative Treatment / Q000191:economics / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D005593:Fracture Fixation, Internal / Q000191:economics / Q000401:mortality; D017048:Health Care Costs; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D015996:Survival Rate