Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden
(2020) In Scandinavian Journal of Public Health 48(1). p.72-79- Abstract
AIM: To assess the absolute and relative educational inequalities in mortality from hip and non-hip fractures in Skåne region, Sweden.
METHODS: We conducted a population-based open cohort study. People aged 30-99 years, resident in the region during 1998-2013 ( n = 999, 148) were followed until death, their 100th birthday, relocation outside Skåne, or the end of 2014. We obtained individual-level data from the Statistics Sweden and the Swedish National Board of Health and Welfare's Cause of Death Register. Death certificates coded with any fracture diagnosis were defined as fracture-related deaths. Educational inequalities were assessed by slope and relative indices of inequality (SII and RII). Cox regression and additive hazard... (More)
AIM: To assess the absolute and relative educational inequalities in mortality from hip and non-hip fractures in Skåne region, Sweden.
METHODS: We conducted a population-based open cohort study. People aged 30-99 years, resident in the region during 1998-2013 ( n = 999, 148) were followed until death, their 100th birthday, relocation outside Skåne, or the end of 2014. We obtained individual-level data from the Statistics Sweden and the Swedish National Board of Health and Welfare's Cause of Death Register. Death certificates coded with any fracture diagnosis were defined as fracture-related deaths. Educational inequalities were assessed by slope and relative indices of inequality (SII and RII). Cox regression and additive hazard models were used to estimates these indices.
RESULTS: During a mean follow-up of 12.2 years, there were 5,121 fracture-related deaths, of which 3,110 were associated with hip fracture. Age-standardized, hip fracture-related mortality rates per 100,000 person-years were 31, 95% confidence interval (CI) (30, 32) and 23 (20, 26) in people with low and high levels of education, respectively (rate ratio 1.4, 95% CI (1.2, 1.5)). Corresponding mortality rates for non-hip-fracture related deaths were 20 (18, 21) and 16 (14, 19) (rate ratio 1.2, 95% CI (1.0, 1.4)). SII and RII revealed educational inequalities in hip fracture-related mortality in favour of highly educated people. For non hip fracture-related mortality, there were statistically significant educational inequalities in people aged <70 years.
CONCLUSIONS: We found higher fracture-related mortality with lower education suggesting preventative and therapeutic interventions for fractures should pay special attention to people with low-level education.
(Less)
- author
- Lindéus, Maria LU ; Englund, Martin LU and Kiadaliri, Aliasghar A LU
- organization
- publishing date
- 2020-02-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Scandinavian Journal of Public Health
- volume
- 48
- issue
- 1
- pages
- 8 pages
- publisher
- SAGE Publications
- external identifiers
-
- pmid:30345871
- scopus:85059686982
- ISSN
- 1651-1905
- DOI
- 10.1177/1403494818807831
- project
- Socioeconomic inequalities in musculoskeletal disorders outcomes and care
- Socioeconomic inequalities in musculoskeletal disorders burden
- language
- English
- LU publication?
- yes
- id
- 66e70866-fa34-409e-bc0e-85dc35c745df
- date added to LUP
- 2018-10-23 11:32:50
- date last changed
- 2024-04-01 13:38:07
@article{66e70866-fa34-409e-bc0e-85dc35c745df, abstract = {{<p>AIM: To assess the absolute and relative educational inequalities in mortality from hip and non-hip fractures in Skåne region, Sweden.</p><p>METHODS: We conducted a population-based open cohort study. People aged 30-99 years, resident in the region during 1998-2013 ( n = 999, 148) were followed until death, their 100th birthday, relocation outside Skåne, or the end of 2014. We obtained individual-level data from the Statistics Sweden and the Swedish National Board of Health and Welfare's Cause of Death Register. Death certificates coded with any fracture diagnosis were defined as fracture-related deaths. Educational inequalities were assessed by slope and relative indices of inequality (SII and RII). Cox regression and additive hazard models were used to estimates these indices.</p><p>RESULTS: During a mean follow-up of 12.2 years, there were 5,121 fracture-related deaths, of which 3,110 were associated with hip fracture. Age-standardized, hip fracture-related mortality rates per 100,000 person-years were 31, 95% confidence interval (CI) (30, 32) and 23 (20, 26) in people with low and high levels of education, respectively (rate ratio 1.4, 95% CI (1.2, 1.5)). Corresponding mortality rates for non-hip-fracture related deaths were 20 (18, 21) and 16 (14, 19) (rate ratio 1.2, 95% CI (1.0, 1.4)). SII and RII revealed educational inequalities in hip fracture-related mortality in favour of highly educated people. For non hip fracture-related mortality, there were statistically significant educational inequalities in people aged <70 years.</p><p>CONCLUSIONS: We found higher fracture-related mortality with lower education suggesting preventative and therapeutic interventions for fractures should pay special attention to people with low-level education.</p>}}, author = {{Lindéus, Maria and Englund, Martin and Kiadaliri, Aliasghar A}}, issn = {{1651-1905}}, language = {{eng}}, month = {{02}}, number = {{1}}, pages = {{72--79}}, publisher = {{SAGE Publications}}, series = {{Scandinavian Journal of Public Health}}, title = {{Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden}}, url = {{http://dx.doi.org/10.1177/1403494818807831}}, doi = {{10.1177/1403494818807831}}, volume = {{48}}, year = {{2020}}, }