PhD dissertation: Social inequalities in incidence and consequences of fragility fractures

Fragility fractures, especially of the hip and vertebra, constitute a major and growing public health problem across the world. Mortality rates among older people with hip fracture is approximately 25% within the first year of the injury, and the risk of dying is increased up to eight-fold within the first three months after fracture.

Survivors of fragility fractures suffer temporary or permanent disabilities such as pain, decreased mobility and increased dependency on others, potentially imposing important limitations on their health related quality of life (HRQoL). The association between a higher burden of chronic disease and lower socio-economic status (SES) is well established.

Studies conducted throughout the world have consistently shown that lower SES is associated with increased morbidity from most diseases, lower HRQoL, shorter life expectancy and increased overall mortality across the lifespan. Despite this wellestablished social gradient in morbidity and mortality from most diseases, the impact of SES on incidence and consequences of fragility fractures among elderly remains unclear.

Studies investigating these associations have generated diverging results. These inconsistencies may be due to the use of different measures of SES across studies (e.g. education, income, occupation or Index of Multiple Deprivation) and differences in study size, duration of follow-up or methodological quality. Thus, the aim of this PhD was to establish the impact of SES on fragility fracture incidence and outcome.

Knowledge of the impact of SES on the incidence and consequences of fractures among elderly is important to inform future health policy aiming to reduce cost and suffering associated with fractures.

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