Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study
ABSTRACT Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–r...
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Online Access: | https://doi.org/10.1002/jbm4.10236 |
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doaj-555dfad97d4a4df9927cd0bc743393612021-05-02T03:02:17ZengWileyJBMR Plus2473-40392019-11-01311n/an/a10.1002/jbm4.10236Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS StudySiri M Solbakken0Jeanette H Magnus1Haakon E Meyer2Cecilie Dahl3Hein Stigum4Anne J Søgaard5Kristin Holvik6Grethe S Tell7Nina Emaus8Siri Forsmo9Clara G Gjesdal10Berit Schei11Peter Vestergaard12Tone K Omsland13Institute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo NorwayFaculty of Medicine University of Oslo Oslo NorwayInstitute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo NorwayInstitute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo NorwayInstitute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo NorwayDepartment of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo NorwayDepartment of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo NorwayDepartment of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo NorwayDepartment of Health and Care Sciences The Arctic University of Norway Tromsø NorwayDepartment of Public Health and Nursing Norwegian University of Science and Technology Trondheim NorwayDepartment of Clinical Science University of Bergen Bergen NorwayDepartment of Public Health and Nursing Norwegian University of Science and Technology Trondheim NorwayDepartment of Clinical Medicine Aalborg University Aalborg DenmarkInstitute of Health and Society, Department of Community Medicine and Global Health University of Oslo Oslo NorwayABSTRACT Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.https://doi.org/10.1002/jbm4.10236AGINGEPIDEMIOLOGYGENERAL POPULATION STUDIESOSTEOPOROSISSTATISTICAL METHODS |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Siri M Solbakken Jeanette H Magnus Haakon E Meyer Cecilie Dahl Hein Stigum Anne J Søgaard Kristin Holvik Grethe S Tell Nina Emaus Siri Forsmo Clara G Gjesdal Berit Schei Peter Vestergaard Tone K Omsland |
spellingShingle |
Siri M Solbakken Jeanette H Magnus Haakon E Meyer Cecilie Dahl Hein Stigum Anne J Søgaard Kristin Holvik Grethe S Tell Nina Emaus Siri Forsmo Clara G Gjesdal Berit Schei Peter Vestergaard Tone K Omsland Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study JBMR Plus AGING EPIDEMIOLOGY GENERAL POPULATION STUDIES OSTEOPOROSIS STATISTICAL METHODS |
author_facet |
Siri M Solbakken Jeanette H Magnus Haakon E Meyer Cecilie Dahl Hein Stigum Anne J Søgaard Kristin Holvik Grethe S Tell Nina Emaus Siri Forsmo Clara G Gjesdal Berit Schei Peter Vestergaard Tone K Omsland |
author_sort |
Siri M Solbakken |
title |
Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study |
title_short |
Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study |
title_full |
Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study |
title_fullStr |
Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study |
title_full_unstemmed |
Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study |
title_sort |
urban–rural differences in hip fracture mortality: a nationwide norepos study |
publisher |
Wiley |
series |
JBMR Plus |
issn |
2473-4039 |
publishDate |
2019-11-01 |
description |
ABSTRACT Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. |
topic |
AGING EPIDEMIOLOGY GENERAL POPULATION STUDIES OSTEOPOROSIS STATISTICAL METHODS |
url |
https://doi.org/10.1002/jbm4.10236 |
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1721495830946381824 |