International Journal for Quality in Health Care Advance Access originally published online on October 19, 2009
International Journal for Quality in Health Care 2009 21(6):379-386; doi:10.1093/intqhc/mzp046
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture
Department of Epidemiology, Local Health Authority RME, Via di S. Costanza, 53, Rome 00198, Italy
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.
Settings 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.
Keywords: hip fracture, inequalities, information systems, mortality, surgery
Address reprint requests to: Anna Patrizia Barone, Department of Epidemiology, Local Health Authority RME, Via di S. Costanza, 53, Rome 00198, Italy. Tel: +39-06-83060340; Fax: +39-06-83060463; E-mail: barone{at}asplazio.it
Accepted for publication September 22, 2009.