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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
  1. Carla Maria Oliveira1,2,3,4,5,
  2. Sandra Maria Alves1,2,3,
  3. Maria Fátima Pina1,2,4,6,7
  1. 1i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
  2. 2INEB—Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
  3. 3ESTSP/IPP—Escola Superior de Tecnologia da Saúde do Porto, Instituto Politécnico do Porto, Vila Nova de Gaia, Portugal
  4. 4FMUP—Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  5. 5ISPUP—Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
  6. 6ICICT/FIOCRUZ—Instituto de Comunicação e Informação em Saúde/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
  7. 7CARTO-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
  1. Correspondence to i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208. 4200–135 Porto, Portugal;

Abstract

Background 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.

Methods 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.

Results 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).

Conclusions 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.

  • FRACTURES
  • OSTEOPOROSIS
  • SOCIAL INEQUALITIES
  • TIME-SERIES
  • MODELLING

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