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

TY - JOUR

T1 - Educational inequalities in fracture-related mortality using multiple cause of death data in the Skåne region, Sweden

AU - Lindéus, Maria

AU - Englund, Martin

AU - Kiadaliri, Aliasghar A

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

U2 - 10.1177/1403494818807831

DO - 10.1177/1403494818807831

M3 - Article

C2 - 30345871

VL - 48

SP - 72

EP - 79

JO - Scandinavian Journal of Public Health

JF - Scandinavian Journal of Public Health

SN - 1651-1905

IS - 1

ER -