Osteoporosis 2016 | The effect of social deprivation on hip fracture incidence has not changed over 10 years in England: Arti Gauvri Bhimjiyani #osteo2016
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Elizabeth Curtis's presentation from Osteoporosis 2016: Variation in UK fracture incidence by age, sex, geography, ethnicity, socioeconomic status, and time: results from the UK CPRD:
Find out more at: https://nos.org.uk/conference
Dr Zoe Paskins's presentation from Osteoporosis 2016: Risk of fragility fracture over 10 years across eight inflammatory conditions: A UK population study.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Elizabeth Curtis's presentation from Osteoporosis 2016: Variation in UK fracture incidence by age, sex, geography, ethnicity, socioeconomic status, and time: results from the UK CPRD:
Find out more at: https://nos.org.uk/conference
Dr Zoe Paskins's presentation from Osteoporosis 2016: Risk of fragility fracture over 10 years across eight inflammatory conditions: A UK population study.
Find out more at: https://nos.org.uk/conference
Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Vertebral Fracture Identification presented by Dr Andrew Pearson, Consultant Radiologist, Borders Hospital, Melrose at the fracture liaison service champions' summit 2016. #flschampions
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Sarah Chiu's presentation from Osteoporosis 2016: Impact of falls on fractures and mortality – an opportunity for intervention and enhancement of fracture prediction?
Find out more at: https://nos.org.uk/conference
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Vertebral Fracture Identification presented by Dr Andrew Pearson, Consultant Radiologist, Borders Hospital, Melrose at the fracture liaison service champions' summit 2016. #flschampions
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Sarah Chiu's presentation from Osteoporosis 2016: Impact of falls on fractures and mortality – an opportunity for intervention and enhancement of fracture prediction?
Find out more at: https://nos.org.uk/conference
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Bo Abrahamsen's presentation from Osteoporosis 2016: Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment.
Find out more at: https://nos.org.uk/conference
Kate Ward's presentation from Osteoporosis 2016: Relationships between muscle function and bone microarchitecture in the Hertfordshire cohort study.
Find out more at: https://nos.org.uk/conference
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
Dr Rachel Tattersall's presentation from Osteoporosis 2016: Successful transition from paediatric to adult services.
Find out more at: https://nos.org.uk/conference
Prof. Jon Tobias's presentation from Osteoporosis 2016: What are the properties of the perfect therapy?
Find out more at: https://nos.org.uk/conference
Prof. Richard Keen's presentation from Osteoporosis 2016: Teaching old dogs new tricks? Combination therapy in osteoporosis.
Find out more at: https://nos.org.uk/conference
Osteoporosis 2016 | Factors influencing peak bone mass: Prof. Nick Harvey #os...
Similar to Osteoporosis 2016 | The effect of social deprivation on hip fracture incidence has not changed over 10 years in England: Arti Gauvri Bhimjiyani #osteo2016
Adverse effects of medical treatment in the UK. Lunevicius R. Grand round, Li...Raimundas Lunevicius
1. Despite gains in reducing mortality from adverse effects (AEs) in the UK, progress has not been achieved in the reduction of incidence from AEs between 1990 and 2013
2. A direct link between deprivation level & health loss from AEs in England & the English regions is apparent, though vary, between most deprived & least deprived
3. DEPRIVATION LEVEL MATTERS on outcomes from AEs.
Data Matching: Understanding the Impact of Homelessness on Health ServicesFEANTSA
Neil Hamlet's presentation in the "Effective Health Interventions for Homeless People - Building Bridges Across Sectors" workshop at the FEANTSA Annual European Policy Conference on the 10th of June 2016
Simon stevens presentation - future nhs stage, 12.00, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Valerie Delpech, Public Health Engand
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Standardization of rates by Dr. Basil TumainiBasil Tumaini
Standardization of rates by Dr. Basil Tumaini, presented during the residency at Muhimbili University of Health and Allied Sciences, Epidemiology class
Similar to Osteoporosis 2016 | The effect of social deprivation on hip fracture incidence has not changed over 10 years in England: Arti Gauvri Bhimjiyani #osteo2016 (20)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Osteoporosis 2016 | The effect of social deprivation on hip fracture incidence has not changed over 10 years in England: Arti Gauvri Bhimjiyani #osteo2016
1. The effect of social deprivation on hip
fracture incidence has not changed
over 10 years in England
Arti Bhimjiyani1, Jenny Neuburger2, Yoav Ben-Shlomo3, Celia Gregson1
1Musculoskeletal Research Unit, University of Bristol
2London School of Hygiene and Tropical Medicine, Nuffield Trust London
3School of Social and Community Medicine, University of Bristol
3. Background
• England & Wales: ~65,000 hip fractures per year1
• UK annual hospital costs of incident hip fracture ~£1.1 billion2
• Worsening levels of deprivation are associated with:
• Higher rates of hip fracture3
• Poorer outcomes post-hip fracture4
• Secular trends show an increase in hip fracture incidence for men and
plateau for women in the UK5
• Unclear how the association between deprivation and incident hip fracture
has changed over the last decade
1 National Hip Fracture Database annual report 2015. London: RCP, 2015 4 Thorne K et al. Ost Int. 2016;27(9):2727-37
2 Leal J et al. Ost Int. 2016 Feb;27(2):549-58 5 van der Velde et al. Ost Int. 2016;27(11):3197-3206
3 Quah C et al. JBone Joint SurgBr. 2011;93(6):801-5
4. Hypothesis & Aims
Hypothesis
• Secular changes in hip fracture incidence have not occurred
equally across all levels of deprivation
i.e. any declines in incidence are likely to be seen predominantly in
less deprived people
Aims
• To determine the association between deprivation and hip
fracture incidence, by gender
• To examine if secular trends in hip fracture incidence over 10
years differ by deprivation and gender
5. Hypothesis & Aims
Hypothesis
• Secular changes in hip fracture incidence have not occurred
equally across all levels of deprivation
i.e. any declines in incidence are likely to be seen predominantly in
less deprived people
Aims
• To determine the association between deprivation and hip
fracture incidence, by gender
• To examine if secular trends in hip fracture incidence over 10
years differ by deprivation and gender
6. Data source: Hospital Episode Statistics (HES)
• Anonymised, patient-level data extract from the HES Admitted
Patient Care database
• Routinely collected data from all English NHS hospitals
• Time period: April 2001 to March 2012
• Study Population
• Male and female English residents aged ≥50 years
• Patients admitted with an index hip fracture (i.e. 1st hip
fracture), or in-hospital index hip fractures
7. HES Exposure: Index of Multiple Deprivation (IMD) 2010
• Based on a classification of 32,482 local areas
defined by an individual’s postcode
• 7 domains:
1. Education, skills & training 5. Crime
2. Barriers to housing & services 6. Income
3. Health & disability 7.Employment
4. Living environment
• Quintiles-based ranking of IMD scores:
Q1 – Least deprived
.
.
.
Q5 – Most deprived
Source: Index of Multiple Deprivation 2010
Neighbourhood Statistics Release
8. HES Outcome: Hip Fracture
ICD-10 disease codes:
• S72.0 (Fracture of Neck of Femur)
• S72.1 (Pertrochanteric fracture)
• S72.2 (Subtrochanteric fracture)
9. HES Outcome: Hip Fracture
ICD-10 disease codes:
• S72.0 (Fracture of Neck of Femur)
• S72.1 (Pertrochanteric fracture)
• S72.2 (Subtrochanteric fracture)
Mid-year population estimates for England
• Years 2001 to 2012
• Stratified by: Age in 5-year intervals
Gender
IMD 2015 quintile
Population Denominator: Office for National Statistics (ONS)
10. Statistical Analyses
• Annual incidence rates of hip fracture per 100,000 population:
Number of index hip fractures x 100,000 by each strata of gender
Population count & IMD per year
• Age-standardised (direct) hip fracture incidence rates for males and females
stratified by IMD quintiles (reference year: 2001)
• Poisson regression modelling of the association between IMD & hip fracture
incidence
• Incident rate ratios (IRRs) (95% confidence interval), adjusted for age, stratified by
IMD quintiles & gender
• Reference cat. least deprived quintile (Q1)
• Formal tests for interaction
11. Total Hip Fracture Population: 2001 to 2011
N (%)
No. of patients with hip fracture 577,767
Female (%) 433,983 (75)
IMD Quintile 1 (Least deprived) 109,265 (18.9)
Q2 120,566 (20.9)
Q3 122,751 (21.3)
Q4 115,080 (19.9)
Quintile 5 (Most deprived) 110,105 (19.1)
Age (years) mean (SD) 81.6 (9.4)
12. 0.9
1
1.1
1.2
1.3
1.4
Q1 Q2 Q3 Q4 Q5
IncidentRateRatios(IRRs)
Males
Greater deprivation associated with higher incidence in
men but less marked for women
Poisson regression modelling adjusted for age
Formal test for gender x deprivation interaction (adjusted for age) p<0.001
0.9
1
1.1
1.2
1.3
1.4
Q1 Q2 Q3 Q4 Q5
IncidentRateRatios(IRRs)
Females
13. 0
100200300400500
2001 2003 2005 2007 2009 2011
Year
Female age-standardised incidence is declining over time
whilst rates have slightly increased for men
Females
Males
95% CIs have not been shown as very narrow
Time x gender interaction
(adjusted for age) p<0.001
Annual % increase: 0.81%
Annual % decline: 1.18%
14. Age-Standardised Incidence Rates by IMD Quintiles for
MEN
No evidence of time x deprivation
interaction (adjusted for age)
p=0.61
0
50
100150200250300
2001 2003 2005 2007 2009 2011
Year
Q5
Q1
Deprivation Annual %
change
Q1 +0.90
.
.
.
Q5 +0.78
15. 0
100200300400
2001 2003 2005 2007 2009 2011
Year
Age-Standardised Incidence Rates by IMD Quintiles for
WOMEN
Time x deprivation interaction
(adjusted for age)
p<0.001
Q5
Q1
Deprivation Annual %
change
Q1 -1.42
.
.
.
Q5 -0.89
16. Limitations
• We used an area-based measure of deprivation as a proxy for
individual deprivation
• Quality of HES coding may have changed over time
• We lack co-morbidity data
• Our results are derived from English data only
17. Conclusions
• Deprivation is a stronger predictor of adult hip fracture incidence in
men than women
• Hip fracture incidence has declined in women and increased in men
across all strata of deprivation from 2001-2011
• There has been no narrowing of the gap between levels of deprivation
for men, with some widening of the gap for women, despite national
efforts to reduce hip fracture incidence
• Our findings have implications for equity of access to fracture
prevention programs nationally
Good afternoon everyone. My name is Arti Bhimjiyani. I am a second year PhD student based in the Musculoskeletal Research Unit at the University of Bristol.
Today I will be presenting analyses conducted as part of my PhD.
Hip fractures are common. The National Hip Fracture Database reports that around 65,000 hip fractures occur each year in England, Wales and NI
And the financial impact of hip fractures to the health service is high. A recent study estimated the annual hospital costs associated with incident hip fractures to be approximately £1.1 billion pounds for the UK
A study conducted in Nottingham showed that worsening levels of deprivation were associated with higher rates of hip fracture
Furthermore, worsening levels of social deprivation have been associated with increased mortality in England
A recent study by Van der Velde and colleagues showed that secular trends in hip fracture incidence increased in men but plateaued in women over a 20-year period in the UK
However, it is unclear how the association between deprivation and incident hip fractures has changed over the last decade
We hypothesised that secular changes in hip fracture incidence have not occurred equally across all levels of deprivation, that is, any declines in incidence are likely to be seen predominantly amongst people who are less deprived
The aim of this study was two-fold.
Firstly, we aimed to determine the association between area deprivation and hip fracture incidence, by gender.
And secondly, to examine if the secular trends in hip fracture incidence over 10 years differ by deprivation and gender
We hypothesised that secular changes in hip fracture incidence have not occurred equally across all levels of deprivation, that is, any declines in incidence are likely to be seen predominantly amongst people who are less deprived
The aim of this study was two-fold.
Firstly, we aimed to determine the association between area deprivation and hip fracture incidence, by gender.
And secondly, to examine if the secular trends in hip fracture incidence over 10 years differ by deprivation and gender
We analysed an anonymised, patient-level data extract of routinely collected data from all English hospitals within the National Health Service for the period April 2001 to March 2012
Our study population consisted of index cases of hip fracture, that is the first occurrence of hip fracture, among all English residents aged 50 years and older admitted to hospital with a hip fracture or who sustained a hip fracture during a hospital admission
We used the Index of Multiple Deprivation (IMD) 2010 to measure an individuals level of socio-economic deprivation
The IMD is a measure of deprivation for small areas, of which there were just under 32,500 in England, based on the 2001 population census – shown on the map here, which demonstrates the geographic spread of deprivation in England. Areas in blue are defined as the most deprived and areas in yellow are classified as the least deprived
An individual’s local area and hence IMD score and rank is determined by their postcode.
The IMD is comprised of 7 domains of deprivation, namely
education, skills and training
employment
barriers to housing and services
Living environment
crime
income and
health and disability
We categorised patients into five equal groups based on the national IMD ranking of local areas, with quintile 1 being the least deprived and quintile 5 being the most deprived
We identified our study outcome, that is index cases of hip fracture, using ICD-10 codes for
Fracture of the neck of femur
Pertrochanteric fracture and
Subtrochanteric fracture
We used mid-year population estimates obtained from the Office for National Statistics (ONS) for the years 2001 through to 2011 as our population denominator data
Our denominator data were stratified by age in 5-yearly intervals, gender and IMD quintiles
We calculated annual incidence rates of hip fracture per 100,000 population as the number of index cases of hip fracture divided by the population count for each strata of gender and IMD quintile multiplied by 100,000
We used direct standardisation methods to calculate age-standardised hip fracture incidence rates for males and females stratified by IMD quintiles using the population of England in 2001 as our reference population
We used Poisson regression modelling to determine the association between IMD and hip fracture incidence
And calculated incident rate ratios, adjusting for age, and stratified by IMD quintiles and gender
Using quintile 1, the least deprived quintile, as the reference category for our analyses
We conducted formal tests for interaction between time, gender and deprivation, treating all variables as continuous in our model
We identified approximately 580,000 hospital admissions with an index hip fracture from 2001 to 2011, of which 75% were in women
The mean age of our study population was 82 years
This is a figure of incident rate ratios on the y axis by quintile of deprivation on the x axis, for males and females
Quintile 1, the least deprived quintile, acted as the reference category
This figure demonstrates that hip fracture incidence was highest for men in the most deprived versus the least deprived quintile with greater deprivation being associated with an approximately 1.3-fold increase in the rate of incident hip fracture
An association between greater deprivation and hip fracture incidence was found in women, albeit less marked than the relationship observed in men
We found evidence to suggest that the association between deprivation and hip fracture incidence differed between males and females, i.e. there was a significant gender by deprivation interaction.
We observed differing trends in age-standardised hip fracture incidence by gender with a decline observed for women at a rate of 1.2% per year whilst rates increased slightly for men at a rate of <1% per year over the 10 years
Age-standardised hip fracture incidence rates have increased similarly for men across all strata of deprivation from 2001 to 2011
We found no evidence to suggest that the rate of increase over time has differed by levels of deprivation, i.e. no time by deprivation interaction.
The increases in hip fracture incidence equate to a 0.9% increase in fracture rate per year amongst the least deprived quintile, and a 0.78% increase per year amongst the most deprived quintile
Age-standardised hip fracture incidence has declined in women across all strata of deprivation from 2001 to 2011
However, we found evidence to suggest that hip fracture incidence has decreased over time to a greater extent amongst women in the least deprived quintile compared to the most deprived quintile
So, the declines in hip fracture incidence equate to a 1.42% decline in fracture rate per year amongst the least deprived quintile, and a 0.89% decline per year amongst the most deprived quintile
We recognise the following limitations of this study.
Firstly, we used an area-based measure of deprivation as a proxy for an individual’s level of deprivation, which may not reflect the heterogeneous nature of deprivation within an area
Secondly, the quality of HES coding may have changed over time, which may have influenced the recording of hip fractures over our study period
We were unable to obtain population denominator data stratified by level of co-morbidity and therefore we were unable to take account of secular trends in co-morbidity and it’s impact on trends in hip fracture incidence by deprivation
We analysed hospital admission data that were collected from English hospitals, which may limit the generalisability of our findings to other study populations
We conclude from our study findings that deprivation is a stronger predictor of adult hip fracture incidence in men than in women
Furthermore, hip fracture incidence has declined in women and increased in men across all strata of deprivation from 2001 to 2011
And finally, our findings suggest that there has been no narrowing of the gap between levels of deprivation for men, with some widening of the gap for women.
These trends are seen despite national efforts to reduce hip fracture incidence
Our findings have implications for equity of access to fracture prevention programs nationally
I would like to acknowledge the following people, especially my PhD supervisors Celia Gregson, Jenny Neuburger and Yoav Ben-Shlomo.
I would like to thank the National Osteoporosis Society for funding this project and for the opportunity to present our findings. Thank you for listening.