Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS).

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Osteoporosis International Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI:10.1007/s00198-024-07133-1

Kristin Holvik, Cecilie Dahl, Sven Ove Samuelsen, Anne-Johanne Søgaard, Siri Marie Solbakken, Grethe S Tell, Mari Hoff, Berit Schei, Helena Kames Kjeldgaard, Ellen M Apalset, Bente Morseth, Guri Grimnes, Haakon E Meyer, Tone Kristin Omsland

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Abstract

Examining fracture dynamics by socioeconomic status may inform healthcare and prevention. We found a higher risk of hip fracture in men and women with lower educational level in Norway. However, by age 90 + years, the cumulative incidence was higher in those with higher education, due to their higher life expectancy.

Purpose: Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level.

Methods: In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002-2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression.

Results: The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders.

Conclusions: There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy.

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挪威髋部骨折发病率的教育梯度。挪威骨质疏松症流行病学研究（NOREPOS）。

研究社会经济地位对骨折的影响可为医疗保健和预防提供参考。我们发现，在挪威，教育程度较低的男性和女性发生髋部骨折的风险较高。目的：在高收入国家，一些健康结果存在社会经济梯度。我们旨在研究挪威髋部骨折风险中可能存在的教育梯度，并描述不同教育水平的髋部骨折累积发病率：在一个年龄≥50岁的挪威人口队列中，将挪威统计局提供的受教育程度信息与2002-2019年间医院治疗的髋部骨折和死亡病例联系起来。我们通过 Cox 比例危险度回归估算了不同教育程度（小学、中学或大学）的相对骨折风险。我们还在竞争风险回归中按性别和教育程度研究了不同年龄段的累积发病率：研究对象包括 N = 1,389,858 人，发生髋部骨折 135,938 例。与受过高等教育的男性相比，仅受过小学教育的男性髋部骨折的危险比（95% 置信区间）为 1.44（1.40，1.49），受过中学教育的男性为 1.26（1.22，1.29）。女性的相应估计值分别为 1.28（1.25，1.31）和 1.16（1.13，1.19）。在 50 至 90 岁年龄段，受过初等教育的人群髋部骨折的累积发生率最高。随着年龄的增长，这种梯度逐渐减小，在年龄最大（大于 90 岁）的男女中，这种梯度出现了逆转：挪威男性和女性的髋部骨折发病率都存在明显的教育梯度，教育程度较低的人风险较高。尽管如此，由于预期寿命较长，受过高等教育的人老年髋部骨折的累积发病率最高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Osteoporosis International 医学-内分泌学与代谢

CiteScore

8.10

自引率

10.00%

发文量

224

审稿时长

3 months

期刊介绍： An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.