declare that they have no conflict of interest. Role of funding source:The funder Fundação para a Ciência e Tecnologia -FCT has no role in this paper. Mini-abstractAge modifies the effect of area-level socioeconomic status (SES) in the risk of fragility hip fractures (HF).For older individuals risk of HF increases as SES increases. For younger, risk of HF increases as SES decreases. Our study may aid decisions makers and medical guidelines for HF prevention. Background:The effect of socioeconomic status (SES) on hip fracture (HF) incidence remains unclear.Objective: To evaluate the association between HF incidence and municipality-level SES as well as interactions between age and SES. and to analyze the interaction between age and SES, after adjusting for rural conditions. MethodsResults: There were 96,905 HF, 77.3% of which were on women who on average were older than men (mean age 81.2±8.5 vs 78.2±10.1 years) at admission (p<0.001). In women, there was a lower risk associated with better SES: RR=0.83 (95%CrI 0.65-1.00) for affluent versus deprived. There was an inverse association between SES and HF incidence rate in the youngest and a direct association in the oldest, for both sexes, but significant only between deprived and affluent in older ages (≥75years). Conclusions:Interaction between SES and age may be due to inequalities in lifestyles, access to health systems and preventive actions. These results may help decision-makers to better understand the epidemiology of hip fractures and to better direct the available funding.
Summary An age-period cohort model was fitted to analyse time effects on hip fracture incidence rates by sex (Portugal, 2000(Portugal, -2008. Rates increased exponentially with age (age effect). Incidence rates decreased after 2004 for women and were random for men (period effect). New but comprehensive fluctuations in risk were coincident with major political/economic changes (cohort effect).Introduction Healthcare improvements have allowed preven-tion but have also increased life expectancy, resulting in more people being at risk. Our aim was to analyse the separate effects of age, period and cohort on incidence rates by sex in Portugal, 2000Portugal, -2008 Methods From the National Hospital Discharge Register, we selected admissions (aged ≥49 years) with hip fractures (ICD9-CM, codes 820.x) caused by low/moderate trauma (falls from standing height or less), readmissions and bone cancer cases. We calculated person-years at risk using population data from Statistics Portugal. To identify period and cohort effects for all ages,we usedanage-period-cohort model (1-year in-tervals) followed by generalised additive models with a negative binomial distribution of the observed incidence rates of hip fractures. Results There were 77,083 hospital admissions (77.4 % women). Incidence rates increased exponentially with age for both sexes (age effect). Incidence rates fell after 2004 for women and were random for men (period effect). There was a general cohort effect similar in both sexes; risk of hip fracture altered from an increas-ing trend for those born before 1930 to a decreasing trend following that year. Risk alterations (not statistically significant) coincident with major political and economic change in the history of Portugal were observed around birth cohorts 1920 (stable-increasing), 1940 (decreasing-increasing) and 1950 (in-creasing-decreasing only among women). Conclusions Hip fracture risk was higher for those born dur-ing major economically/politically unstable periods. Although bone quality reflects lifetime exposure, conditions at birth may determine future risk for hip fractures.
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