Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study

Tone K Omsland; John A Eisman; Øyvind Naess; Jacqueline R Center; Clara G Gjesdal; Grethe S Tell; Nina Emaus; Haakon E Meyer; Anne Johanne Søgaard; Kristin Holvik; Berit Schei; Siri Forsmo; Jeanette H Magnus

doi:10.1002/jbmr.2579

Educational Inequalities in Post-Hip Fracture Mortality: A NOREPOS Study

J Bone Miner Res. 2015 Dec;30(12):2221-8. doi: 10.1002/jbmr.2579. Epub 2015 Jul 14.

Authors

Tone K Omsland^{1

2}, John A Eisman^{3

4

5

6}, Øyvind Naess^{1

2}, Jacqueline R Center^{3

4

6}, Clara G Gjesdal^{7

8}, Grethe S Tell⁹, Nina Emaus¹⁰, Haakon E Meyer^{1

2}, Anne Johanne Søgaard², Kristin Holvik², Berit Schei^{11

12}, Siri Forsmo¹¹, Jeanette H Magnus¹

Affiliations

¹ Institute of Health and Society, Department of Community Medicine, University of Oslo, Oslo, Norway.
² Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
³ Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia.
⁴ Department of Endocrinology, St Vincent's Hospital, Sydney, Australia.
⁵ School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.
⁶ St. Vincent's Clinical School, University of New South Wales, Sydney, Australia.
⁷ Department of Rheumatology, Haukeland University Hospital, Bergen, Bergen, Norway.
⁸ Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
⁹ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹⁰ Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromso, Norway.
¹¹ Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
¹² Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.

PMID: 26085117
DOI: 10.1002/jbmr.2579

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.

Keywords: EDUCATION; HIP FRACTURE; MORTALITY; SOCIOECONOMY.

MeSH terms

Aged
Comorbidity
Educational Status
Female
Hip Fractures / complications
Hip Fractures / epidemiology*
Hip Fractures / mortality*
Humans
Male
Middle Aged
Norway
Registries
Risk Factors
Social Class