The association between socioeconomic status and osteoporotic fracture in population-based adults: A systematic review

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Osteoporosis International (Impact Factor: 4.17). 09/2009; 20(9):1487-97. DOI: 10.1007/s00198-008-0822-9
Source: PubMed


Although socioeconomic status (SES) is inversely related to most diseases, this systematic review showed a paucity of good quality data examining influences of SES on osteoporotic fracture to confirm this relationship. Further research is required to elucidate the issue and any underlying mechanisms as a necessary precursor to considering intervention implications.
The association between socioeconomic status (SES) and musculoskeletal disease is little understood, despite there being an inverse relationship between SES and most causes of morbidity. We evaluated evidence of SES as a risk factor for osteoporotic fracture in population-based adults.
Computer-aided search of Medline, EMBASE, CINAHL, and PsychINFO from January 1966 until November 2007 was conducted. Identified studies investigated the relationship between SES parameters of income, education, occupation, type of residence and marital status, and occurrence of osteoporotic fracture. A best-evidence synthesis was used to summarize the results.
Eleven studies were identified for inclusion, which suggested a lack of literature in the field. Best evidence analysis identified strong evidence for an association between being married/living with someone and reduced risk of osteoporotic fracture. Limited evidence exists of the relationship between occupation type or employment status and fracture, or for type of residence and fracture. Conflicting evidence exists for the relationship between osteoporotic fracture and level of income and education.
Limited good quality evidence exists of the role SES might play in osteoporotic fracture. Further research is required to identify whether a relationship exists, and to elucidate underlying mechanisms, as a necessary precursor to considering intervention implications.

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    • "These variables include marital status [8,23–25], living arrangements [23], income [7,8,25–27], employment [8] [24] [25], social support [24], types of residence [8] and education level [8] [25] [26]. Brennan, et al. [9] [28] in their systematic review highlighted the significant heterogeneity of SES markers and outcomes in bone health studies leading to a lack of overall consensus with some showing social deprivation being related to poor bone health and some no effect at all. This highlights the strength of the IMD which is able to include most of these socioeconomic variables, and smaller geographical areas to represent a more accurate picture of SES. "
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    ABSTRACT: Background This study aims to better understand the relationship between socioeconomic status (SES), fractures in those that attend an outpatient fracture clinic and a diagnosis of osteoporosis. This will further aid our ability to risk stratify patients’ with fractures for further investigation and secondary management of their bone health. Method This is a cross sectional analysis using data from the Nottingham Fracture Liaison Service of patients attending the outpatient fracture clinic from 1/01/08 to 31/12/11. Logistic regression adjusted for age and gender were used to investigate SES, fractures and a diagnosis of osteoporosis. Fisher's exact test was used to compare DXA attendance in those living in most deprived and least deprived area. A cut off of 65 years was used to conduct subset analysis of a younger and an older group. Results 6362 patients (1346 male, 5016 female; mean(SD) age, 69(12)) were included in the study. There was no relationship between SES, proportion of fracture types and having a diagnosis of osteoporosis. Prevalence of osteoporosis in each SES quintile from 1 (most deprived) to 5 (least deprived) was 26.68%, 29.04%, 24.83%, 25.67% and 26.68% respectively. The least deprived quintile compared with the most deprived was not associated with a diagnosis of osteoporosis (OR 0.97; 95% CI 0.76-1.25, p = 0.837). Those living in the most deprived area were less likely to attend their bone density scan appointment compared to those living in the least deprived area (OR 0.56; 95% CI 0.44-0.7, p < 0.0001). Conclusion This study has shown that there is no relationship between SES, fracture types and a diagnosis of osteoporosis in those that present to the fracture clinic. SES should not be used to risk stratify patients for further bone health management after fractures. Those living in the most deprived areas are less likely to attend their bone density scan and efforts need to be made to improve attendance in this group.
    Injury 10/2014; 46(2). DOI:10.1016/j.injury.2014.10.002 · 2.14 Impact Factor
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    • "In The U.S., all of the conditions examined have been shown to be associated with income, and for most conditions are attenuated above the 50th or 66th percentile of income [9,13,15]. Similarly, self-reported health, arthritis, and cardiovascular disorders have been shown to be associated with social class among men age 63-82 in Britain, with a less clear association for pulmonary disorders, diabetes, and musculoskeletal disorders [7,42]. "
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    ABSTRACT: In high income, developed countries, health status tends to improve as income increases, but primarily through the 50(th)-66(th) percentile of income. It is unclear whether the same limitation holds in middle income countries, and for both general assessments of health and specific conditions. Data were obtained from Brazil, a middle income country. In-person interviews with a representative sample of community residents age ≥60 (N=6963), in the southern state of Rio Grande do Sul, obtained information on demographic characteristics including household income and number of persons supported, general health status (self-rated health, functional status), depression, and seven physician-diagnosed, self-reported health conditions. Analyses used household income (adjusted for number supported and economies of scale) together with higher order income terms, and controlled for demographics and comorbidities, to ascertain nonlinearity between income and general and specific health measures. In fully controlled analyses income was associated with general measures of health (linearly with self-rated health, nonlinearly with functional status). For specific health measures there was a consistent linear association with depression, pulmonary disorders, renal disorders, and sensory impairment. For musculoskeletal, cardiovascular (negative association), and gastrointestinal disorders this association no longer held when comorbidities were controlled. There was no association with diabetes. Contrary to findings in high income countries, the association of household-size-adjusted income with health was generally linear, sometimes negative, and sometimes absent when comorbidities were controlled.
    PLoS ONE 09/2013; 8(9):e73930. DOI:10.1371/journal.pone.0073930 · 3.23 Impact Factor
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    • "Our results showed that widowed women have higher level of bone resorption compared with married and divorced subjects after adjustment of age. This finding is in line with a systematic review of the literature by Brennan et al. (2009) which showed a strong evidence for an association between being married or living with someone as being protective against osteoporotic fracture. Farahmand et al. (2000) also found marriage provides protective effect against hip fracture, but the reasons underlying this are still not clear. "
    Sains Malaysiana 08/2013; 42(8):1191-1200. · 0.45 Impact Factor
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