The contributions of first nations ethnicity, income, and delays in surgery on mortality post-fracture : a population-based analysis

Leslie, W. D., Brennan, S. L., Prior, H. J., Lix, L. M., Metge, C. and Elias, B. 2013, The contributions of first nations ethnicity, income, and delays in surgery on mortality post-fracture : a population-based analysis, Osteoporosis international, vol. 24, no. 4, pp. 1247-1256.

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Title The contributions of first nations ethnicity, income, and delays in surgery on mortality post-fracture : a population-based analysis
Author(s) Leslie, W. D.
Brennan, S. L.
Prior, H. J.
Lix, L. M.
Metge, C.
Elias, B.
Journal name Osteoporosis international
Volume number 24
Issue number 4
Start page 1247
End page 1256
Total pages 10
Publisher Springer UK
Place of publication Surrey, England
Publication date 2013-04
ISSN 0937-941X
1433-2965
Keyword(s) ethnicity
fracture
income
mortality
North American
Summary Summary We examined the independent contributions of First Nations ethnicity and lower income to post-fracture mortality. A similar relative increase in mortality associated with fracture appears to translate into a larger absolute increase in post-fracture mortality for First Nations compared to non-First Nations peoples. Lower income also predicted increased mortality post-fracture.

Introduction First Nations peoples have a greater risk of mortality than non-First Nations peoples. We examined the independent contributions of First Nations ethnicity and income to mortality post-fracture, and associations with time to surgery post-hip fracture.

Methods Non-traumatic fracture cases and fracture-free controls were identified from population-based administrative data repositories for Manitoba, Canada (aged ≥50 years). Populations were retrospectively matched for sex, age (within 5 years), First Nations ethnicity, and number of comorbidities. Differences in mortality post-fracture of hip, wrist, or spine, 1996–2004 (population 1, n = 63,081), and the hip, 1987–2002(Population 2, n = 41,211) were examined using Cox proportional hazards regression to model time to death. For hip fracture, logistic regression analyses were used to model the probability of death within 30 days and 1 year.

Results Population 1: First Nations ethnicity was associated with an increased mortality risk of 30–53 % for each fracture type. Lower income was associated with an increased mortality risk of 18–26 %. Population 2: lower income predicted mortality overall (odds ratio (OR) 1.15, 95 % confidence interval (CI) 1.07–1.23) and for hip fracture cases (OR 1.18, 95%CI 1.05–1.32), as did older age, male sex, diabetes, and >5 comorbidities (all p ≤ 0.01). Higher mortality was associated with pertrochanteric fracture (OR 1.14, 95 % CI 1.03–1.27), or surgery delay of 2–3 days (OR 1.34, 95 % CI 1.18–1.52) or ≥4 days (OR 2.35, 95 % CI 2.07–2.67).

Conclusion A larger absolute increase in mortality post-fracture was observed for First Nations compared to non-First Nations peoples. Lower income and surgery delay >2 days predicted mortality post-fracture. These data have implications regarding prioritization of healthcare to ensure targeted, timely care for First Nations peoples and/or individuals with lower income.
Language eng
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, International Osteoporosis Foundation and National Osteoporosis Foundation
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047395

Document type: Journal Article
Collection: School of Medicine
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