Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture

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Abstract

Objective: In countries where the National Health Service provides universal health coverage, socioeconomic position should not influence the quality of health care. We examined whether socioeconomic position plays a role in short-term mortality and waiting time for surgery after hip fracture. Design: Retrospective cohort study. Settings and participants: From the Hospital Information System database, we selected all patients, aged at least 65 years and admitted to acute care hospitals in Rome for a hip fracture between 1 January 2006 and 30 November 2007. The socioeconomic position of each individual was obtained using a city-specific index of socioeconomic variables based on the individual's census tract of residence. Main outcome measures: Three different outcomes were defined: waiting times for surgery, mortality within 30 days and intervention within 48 h of hospital arrival for hip fracture. We used a logistic regression to estimate 30-day mortality and a Cox proportional hazard model to calculate hazard ratios of intervention within 48 h. Median waiting times were estimated by adjusted Kaplan-Meyer curves. Analyses were adjusted for age, gender and coexisting medical conditions. Results: Low socioeconomic level was significantly associated with higher risk of mortality [adjusted relative risk (RR) = 1.51; P < 0.05] and lower risk of early intervention (adjusted RR = 0.32; P < 0.001). Socioeconomic level had also an effect on waiting times within 30 days. Conclusions: Individuals living in disadvantaged census tracts had poorer prognoses and were less likely than more affluent people to be treated according to clinical guidelines despite universal healthcare coverage. © The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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Barone, A. P., Fusco, D., Colais, P., D’Ovidio, M., Belleudi, V., Agabiti, N., … Perucci, C. A. (2009). Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture. International Journal for Quality in Health Care, 21(6). https://doi.org/10.1093/intqhc/mzp046

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