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Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden

Lindéus, Maria LU ; Englund, Martin LU orcid and Kiadaliri, Aliasghar A LU orcid (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.

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author
; and
organization
publishing date
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 &lt;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}},
}