Age–period–cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk

Alves, Sandra Maria Ferreira; Castiglione, Debora de Pina; Oliveira, CM; Sousa, Bruno de; Pina, Maria de Fátima de

doi:10.1007/s00198-013-2483-6

Cited by 15 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This observation, however, suggests that birth cohort effects related to improvements in early-life risk factors, such as maternal and offspring nutrition, leading to a healthier aging population, may contribute to falling fracture rates. This hypothesis is supported by studies from Denmark, (87) Sweden, (34) Canada, (88) Korea, (89) and Portugal, (79) which found birth cohort effects on hip fracture incidence and BMD. For example, in Portugal, hip fracture risk was higher for those born during major economically or politically unstable periods, suggesting that conditions during fetal life or at birth may impact future risk for hip fractures.…”

Section: Discussionmentioning

confidence: 71%

“…(79,80) Increased urbanization could also reflect an associated increase in prosperity and access to medical care, which could, theoretically, increase survival of the frailest elderly, as was recently proposed as a possible contributor to the increase in fracture rates among older Korean women. (81) Of equal interest are the declining rates of fractures now being observed in North America, Europe, Hong Kong, and Taiwan.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Secular Trends in Hip Fractures Worldwide: Opposing Trends East Versus West

Ballane

Cauley

Luckey

et al. 2014

Journal of Bone and Mineral Research

165

118

View full text Add to dashboard Cite

Despite wide variations in hip rates fractures worldwide, reasons for such differences are not clear. Furthermore, secular trends in the age-specific hip fracture rates are changing the world map of this devastating disease, with the highest rise projected to occur in developing countries. The aim of our investigation is to systematically characterize secular trends in hip fractures worldwide, examine new data for various ethnic groups in the United States, evidence for divergent temporal patterns, and investigate potential contributing factors for the observed change in their epidemiology. All studies retrieved through a complex Medline Ovid search between 1966 and 2013 were examined. For each selected study, we calculated the percent annual change in age-standardized hip fracture rates de-novo. Although occurring at different time points, trend breaks in hip fracture incidence occurred in most Western countries and Oceania. After a steep rise in age-adjusted rates in these regions, a decrease became evident sometimes between the mid-seventies and nineties, depending on the country. Conversely, the data is scarce in Asia and South America, with evidence for a continuous rise in hip fracture rates, with the exception of Hong-Kong and Taiwan that seem to follow Western trends. The etiologies of these secular patterns in both the developed and the developing countries have not been fully elucidated, but the impact of urbanization is at least one plausible explanation. Data presented here show close parallels between rising rates of urbanization and hip fractures across disparate geographic locations and cultures. Once the proportion of the urban population stabilized, hip fracture rates also stabilize or begin to decrease perhaps due to the influence of other factors such as birth cohort effects, changes in bone mineral density and BMI, osteoporosis medication use and/or lifestyle interventions such as smoking cessation, improvement in nutritional status and fall prevention.

show abstract

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Secular Trends in Hip Fractures Worldwide: Opposing Trends East Versus West

Ballane

Cauley

Luckey

et al. 2014

Journal of Bone and Mineral Research

165

118

View full text Add to dashboard Cite

show abstract

“…The methods for the classification of municipalities according to SES can be found in detail elsewhere 27. In brief, we reduced a set of 30 socioeconomic and demographic variables related to building, households, families and individuals from the 2001 census into four principal components (PCs), based on the Kaiser Criterion (eigenvalues ≥1), which retained 75.8% of the total variability.…”

Section: Methodsmentioning

confidence: 99%

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000–2010) in Portugal: age and sex temporal trends in a population based study

Oliveira

Alves

Pina

2016

J Epidemiol Community Health

View full text Add to dashboard Cite

Background Socioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000-2010, by regional socioeconomic status (SES), sex and age. Methods We selected registers of patients aged 50+ years with HF (International Classification of Diseases, V.9-Clinical Modification, ICD9-CM) caused by traumas of low/moderate energy, from the National Hospital Discharge Database. Annual time series of age-specific incidence rates were calculated by sex and regional SES (deprived, medium, affluent). Generalised additive models were fitted to identify shape/turning points in temporal trends. Results We selected 96 905 HF (77.3% in women). Women were older than men at admission (81.2±8.5 vs 78.2±10.1 years-old, p<0.001). For women 65-79 years, a continuously decreasing trend (1.7%/year) only in affluent and increasing trends (3.3-3.4%/year) after 2006/2007 in medium and deprived was observed. For men, trends were stable or increased in almost all age/SES groups (only two decreasing periods). For the oldest women, all SES present similar trends: turning points around 2003 (initiating decreasing periods: 1.8-2.9%/year) and around 2007 (initiating increasing periods: 3.7-3.3%/year). Conclusions There were SES-sex-age inequalities in temporal trends during BJD-Portugal: marked SES inequalities among women aged 65-79 years (a persistent, decreasing trend only in the affluent) vanished among the oldest women; the same was not observed in men, for them, there were almost no declining periods; women aged ≥80 years, presented increasing trends around 2007, as in most deprived/age/ sex groups. Despite some successful periods of decreasing trends, incidence rates did not improve overall in almost all age groups and both sexes.

show abstract

“…The many studies highlighting this downturn have not been followed by an equal interest in identifying the responsible mechanism, and many have been satisfied by the coinciding advent and rise of antiresorptive osteoporosis treatment [7], a notion not supported by other studies [6, 8]. …”

Section: Introductionmentioning

confidence: 99%

Recent hip fracture trends in Sweden and Denmark with age-period-cohort effects

et al. 2016

View full text Add to dashboard Cite

SummaryThis study used nationwide hip fracture data from Denmark and Sweden during 1987–2010 to examine effects of (birth) cohort and period. We found that time trends, cohort, and period effects were different in the two countries. Results also indicated that hip fracture rates may increase in the not so far future.IntroductionThe reasons for the downturn in hip fracture rates remain largely unclear but circumstances earlier in life seem important.MethodsWe ascertained hip fractures in the populations ≥50 years in Denmark and Sweden in national discharge registers. Country- and sex-specific age-period-cohort (APC) effects during 1987–2010 were evaluated by log-likelihood estimates in Poisson regression models presented as incidence rate ratios (IRR).ResultsThere were 399,596 hip fractures in SE and 248,773 in DK. Age-standardized hip fracture rate was stable in SE men but decreased in SE women and in DK. Combined period + cohort effects were generally stronger in SE than DK and in women than men. IRR per period ranged from 1.05 to 1.30 in SE and 0.95 to 1.21 in DK. IRR per birth cohort ranged from 1.07 to 3.13 in SE and 0.77 to 1.67 in DK. Relative period effects decreased with successive period in SE and described a convex curve in DK. Relative cohort effects increased with successive birth cohort in both countries but with lower risks for DK women and men and SE women born around the 1930s (age 75–86 years today and responsible for most hip fractures) partly explaining the recent downturn. Men and women born thereafter however seem to have a higher hip fracture risk, and we expect a reversal of the present decline in rates, with increasing hip fracture rates in both Denmark and Sweden during the upcoming decade.ConclusionsTime trends, cohort, and period effects were different in SE and DK. This may reflect differences in general health as evident in known differences in life expectancy, healthcare organization, and prevention such as use of anti-osteoporosis drugs. Analyses indicate that hip fracture rates may increase in the not so far future.Electronic supplementary materialThe online version of this article (doi:10.1007/s00198-016-3768-3) contains supplementary material, which is available to authorized users.

show abstract

Age–period–cohort effects in the incidence of hip fractures: political and economic events are coincident with changes in risk

Cited by 15 publications

References 27 publications

Secular Trends in Hip Fractures Worldwide: Opposing Trends East Versus West

Secular Trends in Hip Fractures Worldwide: Opposing Trends East Versus West

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000–2010) in Portugal: age and sex temporal trends in a population based study

Recent hip fracture trends in Sweden and Denmark with age-period-cohort effects

Contact Info

Product

Resources

About