Elsevier

Public Health

Volume 118, Issue 8, December 2004, Pages 576-581
Public Health

Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status?

https://doi.org/10.1016/j.puhe.2004.02.006Get rights and content

Abstract

Objective. To determine the relationship between hospital admissions for falls and hip fracture in elderly people and area characteristics such as socio-economic deprivation.

Study design. Ecological study of routinely collected hospital admissions data for falls and hip fracture in people aged 75 years or over for 1992–1997, linked at electoral ward level with characteristics from census data.

Methods. In total, 42,293 and 17,390 admissions were identified for falls and hip fracture, respectively, from 858 electoral wards in Trent. Rate ratios (RRs) for hospital admissions for falls and hip fracture were calculated by the electoral wards' Townsend score divided by quintiles. RRs were estimated by negative binomial regression and adjusted for the ward characteristics of age, gender, ethnicity, rurality, proportion of elderly people living alone and distance from hospital.

Results. There was a small but statistically significant association at electoral ward level between hospital admissions for falls and the Townsend score, with the most deprived wards having a 10% higher admission rate for falls compared with the most affluent wards (adjusted RR 1.10, 95% CI 1.01–1.19). No association was found between hospital admission for hip fracture and deprivation (adjusted RR 1.05, 95% CI 0.95–1.16).

Conclusion. There is some evidence of an association at electoral ward level between hospital admissions for falls and socio-economic deprivation, with higher rates in deprived areas. No such association was found for hip fracture. Further work is required to assess the impact of interventions on reducing inequalities in hospital admission rates for falls in elderly people.

Introduction

Falls are a major cause of disability and the leading cause of mortality due to injury in people aged 75 years and over in the UK. Hip fracture is the most common serious injury related to falls in older people; following hip fracture, up to 33% of people will die in the following year. Community studies have estimated that about half of people aged 85 years and over will fall at least once a year and the incidence is rising.1., 2. Falls and hip fracture can also have a detrimental impact on function, quality of life and change in residential status; for example, up to 50% of older people who have a hip fracture are subsequently unable to live independently.3., 4., 5.

The National Service Framework for Older People2 aims to reduce the number of falls that result in a serious injury. The NHS therefore needs to take action to prevent falls in populations of older people regardless of socio-economic status. Whilst we know that there are steep socio-economic gradients for hospital admissions for falls in children,6 little is known about the population level factors related to high admission rates for falls in elderly people such as socio-economic status, type of housing, population density and urban or rural living areas. Such knowledge would clearly help to decide whether fall prevention programmes should be targeted to specific populations.7 More is known about population level factors associated with hip fracture, although few studies have been conducted in the UK. There is substantial variation in the incidence of hip fracture between populations,8 and fracture rates may9 or may not be higher in urban compared with rural areas.10 Low income is associated with higher hip fracture rates in some11., 12. but not all13 studies.

The aim of this study was to determine whether rates of hospital admission for falls and hip fracture are related to material deprivation at the population level.

Section snippets

Study population

Our sample consisted of all hospital admissions for falls or hip fracture from 858 electoral wards in the Trent region between 1 April 1992 and 31 March 1997 for adults aged 75 years or over. These admissions were identified from the Trent NHS regional admissions databases using ICD-9 and ICD-10 diagnosis codes. For falls, codes E880–E888 and W00–W19 were used. Patients with hip fracture were identified by searching on ICD codes relating to fractured neck of femur (ICD 9 820, 821; ICD 10 S72).

The study population

There were a total of 315,211 individuals aged 75 years and over registered at the 1991 Census in the 858 wards in Trent. Of those aged 75 years or over, 31.3% were aged 80–84 years, 21.1% were aged 85 years or over and 35.2% were male. The median number of people aged 75 years and over per ward was 283 and the median total ward population was 4112 (Table 1). The median proportion of elderly people living alone was 5.5%, the median Townsend score was −0.67 and 55% (n=472) of the wards were

Discussion

This study of hospital admissions for falls and hip fracture found a significant association between deprivation (as measured by the Townsend score) and hospital admissions for falls in adults aged 75 years or over. The rates of admission for falls were 10% greater in the two most deprived fifths of wards compared with the most affluent fifth of wards. While these are not particularly high RRs, the absolute number of hospital admissions for falls that occurs is so great that, if this represents

Acknowledgements

This study was funded by a grant from Trent NHS Executive. We thank Andy Nicholson and Howard Chapman from Trent NHS Executive for their help with hospital admissions data extraction, and Maura Bell and April McCambridge for helping process ethical approval. We thank John Gladman for his comments.

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