Summary

We studied the association between deprivation and healthcare costs after hip fracture. Hospital costs in the year following hip fracture were £1120 higher for those living in more deprived areas. Most of this difference was explained by pre-existing health inequalities which should be targeted to reduce this disparity.

Introduction

To quantify differences in hospital costs following hip fracture between those living in higher and lower deprivation areas of England, we investigate pre- and post-fracture variables that explain the association.

Methods

We used English Hospital Episodes Statistics linked to the National Hip Fracture Database (April 2011–March 2015) and national mortality data to identify patients admitted with hip fracture aged 60+ years. Hospital care was costed using 2017/2018 national reference costs, by index of multiple deprivation quintile. Three generalised linear model regressions estimated associations between deprivation and costs and the pre- and post-fracture variables that mediate this relationship.

Results

Patients from the most deprived areas had higher hospital costs in the year post-fracture (£1,120; 95% CI £993 to £1,247) than those from the least deprived areas. If all patients could have incurred similar costs to those in the least deprived quintile, this would equate to an annual reduction in expenditure of £28.8 million. Pre-fracture characteristics, particularly comorbidities and anaesthetic risk grade, accounted for approximately 50% of the association between deprivation and costs. No evidence was found that post-fracture variables, such as transfer to a residential or nursing home, contributed to the association between deprivation and costs.

Conclusions

Socioeconomic inequalities are associated with substantial costs for the NHS after hip fracture. We did not identify post-fracture targets for intervention to reduce the impact of inequalities on post-fracture costs. The case for interventions to reduce comorbid conditions, improve health-related behaviours and prevent falls in deprived areas is clear but challenging to implement.

中文翻译：

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剥夺对髋部骨折后的二级医疗费用有何影响？

概要

我们研究了髋部骨折后剥夺与医疗费用之间的关系。生活在较贫困地区的人，髋部骨折后一年的住院费用要高出1120英镑。大部分这种差异是由先前存在的健康不平等现象引起的，应将其作为减少这一差距的目标。

介绍

为了量化英格兰较高和较低贫困地区的人髋部骨折后住院费用的差异，我们调查了解释这种关联的骨折前后的变量。

方法

我们使用链接到国家髋部骨折数据库（2011年4月至2015年3月）的英语医院情节统计数据和国家死亡率数据来确定60岁以上髋部骨折的患者。医院护理费用使用2017/2018年国家参考成本进行计算，按五分之五的指数划分。三项广义线性模型回归估计了剥夺和成本与调解这种关系的破裂前和破裂后变量之间的关联。

结果

来自最贫困地区的患者在骨折后一年的住院费用更高（1,120英镑； 95％CI 993英镑至1,247英镑），高于那些最不贫困地区的患者。如果所有患者的花费都与最贫穷的五分之一患者相似，那么每年的支出将减少2880万英镑。骨折前特征，特别是合并症和麻醉风险等级，约占剥夺与费用之间关系的50％。没有证据表明断裂后的变量，例如转移到住宅或疗养院，是造成剥夺与费用之间关系的原因。

结论

社会经济不平等与髋部骨折后NHS的巨额成本有关。我们没有确定骨折后的干预目标，以减少不平等对骨折后成本的影响。减少合并症，改善健康相关行为并防止在贫困地区跌倒的干预措施是显而易见的，但实施起来却具有挑战性。