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      Demographic Study of Hip Fractures in the Maltese Islands

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          Abstract

          Introduction:

          Despite hip fractures being a great public health burden, only few studies have analyzed the relationship between hip fracture incidence and socioeconomic status. Many studies found an association; however, results are in part conflicting.

          Objective:

          To analyze the impact of regional-level socioeconomic status on the incidence of hip fractures in the Maltese Islands.

          Method:

          All individuals older than 50 years who presented to the acute care hospitals in Malta and Gozo with low-energy hip fractures between December 1, 2015, and November 30, 2016, were selected. Data on individual demographics, hip fracture type, surgical intervention, and hospital stay were collected. The percentage of hip fracture and socioeconomic status of each region in the Maltese Islands were calculated. These were then analyzed for any statistical association.

          Results:

          A moderate negative correlation ( r = −0.5987, N = 454, P < .05) was found between the socioeconomic status and the incidence of hip fracture in each region. There was 5.9% (n = 27) mortality rate posed by these hip fractures. The average duration of hospital stay was 14 days, with an average delay to surgical intervention of 2 days.

          Conclusion:

          Despite the Maltese Islands having a small population (429 344 people) and a free universal national health service, our results show that districts with low socioeconomic status had a higher incidence of hip fracture. Further studies using individual socioeconomic data and longer duration are required.

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          Most cited references20

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          Latitude, socioeconomic prosperity, mobile phones and hip fracture risk.

          Epidemiological observations suggest that sunlight exposure is an important determinant of hip fracture risk. The aim of this ecological study was to examine the relationship between latitude and hip fracture probability. Hip fracture incidence and mortality were obtained from literature searches and 10-year hip fracture probability computed from fracture and death hazards. There was a significant association between latitude and 10-year hip fracture probability. For each 10 degrees change in latitude from the equator (e.g., from Paris to Stockholm), fracture probability increased by 0.3% in men, by 0.8% in women and by 0.6% in men and women combined. There was also a significant association between economic prosperity and hip fracture risk as judged by gross domestic product (GDP)/capita or the use of mobile phones/capita. A US $10,000 higher GDP/capita was associated with a 1.3% increase in hip fracture probability. The association between latitude and hip fracture probability persisted after adjusting for indices of economic prosperity. These findings provide support for an important role of sunlight exposure in the global variation of hip fracture risk. In addition, there is a need to identify the factors related to socioeconomic prosperity that may provide mechanisms for the variation in hip fracture probability worldwide.
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            Psychosocial factors associated with fall-related hip fractures.

            fall-related injuries in older people are a major public health concern. This study examined the relationship between psychosocial determinants of healthy ageing and risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for promotion of healthy ageing strategies in population-based interventions for fall injury prevention. a case-control study was conducted with 387 participants, with at least two controls recruited per case. Cases of fall-related hip fracture in community-dwelling people aged 65 and older were recruited from hospital admissions in Brisbane, Australia, in 2003-2004. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire assessing psychosocial factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. psychosocial factors having a significant independent protective effect on hip fracture risk included being currently married [OR: 0.44 (0.22 to 0.88)], living in present residence for 5 years or more [OR: 0.43 (0.22 to 0.84)], having private health insurance [OR: 0.49 (0.27 to 0.90)], using proactive coping strategies [OR: 0.52 (0.29 to 0.92)], having a higher level of life satisfaction [OR: 0.47 (0.27 to 0.81)], and engagement in social activities in older age [OR: 0.30 (0.17 to 0.54)]. this study suggests that psychosocial determinants of healthy ageing are protective in fall-related hip fracture injury in older people. Reduction in the public health burden caused by this injury may then be achieved by implementing healthy ageing strategies involving community-based approaches to enhance the psychosocial environments of older people.
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              Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study.

              Urban and rural communities differ in the incidence of several diseases including coronary heart disease and some cancers. Lower hip fracture rates among rural than urban populations have been reported but few studies have compared rural and urban fractures at sites other than the hip. To compare total and site specific fracture rates among adult residents of rural and urban communities within the same population. This is a population based study on osteoporosis in Australia. All fractures occurring in adult residents over a two year period were ascertained using radiological reports. The rural and urban areas are in close proximity, with the same medical, hospital, and radiological facilities permitting uniform fracture ascertainment. All fracture rates were age adjusted and sex adjusted to the Australian population according to the 1996 census of the Australian Bureau of Statistics and described as the rate per 10 000 person years. The p values refer to the adjusted rate difference. The hip fracture rate (incidence per 10 000 person years) was 32% lower (39 v 57, p<0.001), and the total fracture rate 15% lower (160 v 188, p=0.004) among rural than urban residents, respectively. The lower fracture rates in the rural population were also apparent for pelvic fractures. In the older rural population, lower fracture rates at sites typically associated with osteoporosis suggest environmental factors may have a different impact on bone health in this community. If the national rate of hip fracture could be reduced to that of the rural population, the projected increase in hip fracture number attributable to aging of the population could be prevented.
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                Author and article information

                Journal
                Geriatr Orthop Surg Rehabil
                Geriatr Orthop Surg Rehabil
                GOS
                spgos
                Geriatric Orthopaedic Surgery & Rehabilitation
                SAGE Publications (Sage CA: Los Angeles, CA )
                2151-4585
                2151-4593
                23 April 2018
                2018
                : 9
                : 2151459318764772
                Affiliations
                [1 ]Department of Trauma and Orthopaedics, Mater Dei Hospital, Triq Dun Karm, Msida, Malta
                Author notes
                [*]Mark Bugeja, Department of Trauma and Orthopaedics, Mater Dei Hospital, Triq Dun Karm, Msida, MSD 2090, Malta. Email: mbugeja@ 123456gmail.com
                Article
                10.1177_2151459318764772
                10.1177/2151459318764772
                5946341
                f63c6072-f3ff-4de1-ae64-583a2c2606d6
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 16 January 2018
                : 15 February 2018
                : 15 February 2018
                Categories
                Original Article
                Custom metadata
                January-December 2018

                hip fractures,demographic study,socioeconomic,elderly,maltese islands

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