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

Int J Qual Health Care. 2009 Dec;21(6):379-86. doi: 10.1093/intqhc/mzp046. Epub 2009 Oct 19.


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.

Setting: 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.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Female
  • Healthcare Disparities
  • Hip Fractures / economics
  • Hip Fractures / mortality*
  • Hip Fractures / surgery*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • National Health Programs / statistics & numerical data*
  • Retrospective Studies
  • Rome / epidemiology
  • Sex Factors
  • Socioeconomic Factors
  • Time Factors
  • Waiting Lists*