Incident hip fracture and social disadvantage in an Australian population aged 50 years or greater

AimsThere is an inverse association between socioeconomic status (SES) and most causes of morbidity. Hip fractures pose a significant public health burden on society. However, the association between quintiles of area-based SES and incident hip fractures has not been examined in Australia. Using a comprehensive register of hip fractures for the entire Barwon Statistical Division (BSD), we assessed the association between area-based SES and incident hip fractures over a two-year period in residents aged ≥ 50 years.MethodsIncident hip fractures were identified using a computerized keyword search of all radiological reports from all the radiological centers serving the BSD. Pathological fractures were excluded. SES was determined by cross-referencing residential addresses with Australian Bureau of Statistics census data and categorized in quintiles based upon the BSD reference range. Homogeneity of population at risk in each SES quintile was tested using chi square comparison. Hip fractures in each quintile and within each age strata for the entire BSD region were defined as rates per 1000 person-years.ResultsDuring 2006–2007, there were 495 hip fractures (336 female). An inverse pattern of association was observed between SES and hip fracture incidence, with a peak in fracture numbers observed in the second quintile of SES, with differences between SES quintiles observed for both females (p = 0.005) and males (p = 0.007).ConclusionThe association between incident hip fractures and quintiles of area-based SES provides evidence that those of greater social disadvantage should be a specific target population for intervention to reduce the burden of hip fracture within Australia.

Research Highlights
► This study provides evidence for a strong inverse association existing between SES and age-standardized hip fracture in Australia, similar to that reported in many other, but not all, countries.
► A 2-fold difference in fracture risk was observed for those of greater social disadvantage compared to the least disadvantaged.
► Appropriately targeted interventions have the potential to significantly reduce the current burden of fracture experienced by socially disadvantaged individuals in Australia.