Temporal trends in socioeconomic inequalities and risk of infection after hip fracture surgery: a nationwide cohort study, 2010-2021.

UNLABELLED

Socioeconomic inequalities in 30-day risk of any infection after hip fracture surgery increased from 2010 to 2021. The results indicate a growing health gap among patients with hip fracture, whereby lower education, lack of social support, and reliance on informal or residential care represent increasing disadvantages.

PURPOSE

To investigate whether socioeconomic inequalities in infection risk after hip fracture changed between 2010 and 2021.

METHOD

Using Danish population-based registries, we identified 74,068 patients with hip fracture. We collected data on socioeconomic position markers (education, liquid assets, marital status, and living arrangements) to examine their effect on risk of post-surgical infection. We studied any hospital-treated infection or community-treated infection occurring within 30 days after surgery during four calendar periods. We computed the cumulative incidences of infections. We measured inequality over time by estimating the adjusted slope index of inequality (SII), a hazard difference of infection/100 person years, using additive hazard regression and adjusted relative index of inequality (RII), a relative hazard, using Cox proportional hazard regression. We calculated 95% confidence intervals for all estimates.

RESULTS

The incidence of hospital-treated infections (in total 12,654 patients) ranged between 14 and 21% and that of community-treated infections (in total 20,523 patients) ranged between 21 and 38% depending on calendar period and socioeconomic position. During 2010-2021, inequality in hospital-treated infections increased according to education (SII 14 [- 20; 49] and RII 1.1 [0.9; 1.3] in 2010 vs. SII 36 [0; 71] and RII 1.2 [1; 1.3] in 2021) and marital status (SII 29 [- 9; 66] and RII 1.2 [1; 1.4] in 2010 vs. SII 84 [45; 123] and RII 1.4 [1.2; 1.7] in 2021). Similar trends were observed for community-treated infections. Inequality in hospital-treated infection increased according to living arrangements (SII - 32 [- 78; 14] and RII 0.9 [0.7; 1.1] in 2010 vs. SSI 106 [59; 153] and RII 1.5 [1.3; 1.8] in 2021), whereas inequality according to liquid assets remained unchanged over time for both outcomes.

CONCLUSION

Our results indicate growing inequality in health among patients with hip fracture, whereby lower education, lack of social support, and reliance on residential care represent increasing disadvantages for infection risk. This gap may have implications for infection prevention and treatment.