Effect of Socioeconomic Status on Surgery Waiting Times and Mortality After Hip Fractures in Italy.

Abstract

Reducing inequities is a main goal of the Italian healthcare system. We evaluated socioeconomic differences in delayed surgery and postoperative mortality after a hip replacement after a fracture in Piedmont Region (Italy). Cohort study including all people aged ≥65 years hospitalized for a hip fracture in 2007-2010 (n = 21,432). Study outcomes were the following: (1) surgery waiting times >2 days; (2) 30-day, 90-day, and 1-year mortality from admission. Log-binomial models were used to evaluate the effect of socioeconomic status on waiting time, adjusting for age, sex, comorbidities, biennium, and Local Health Unit. Logistic models were fitted for mortality, adjusting also for the type of intervention (prosthesis/reduction) and waiting time. Seventy percent of surgeries were performed beyond 2 days from admission; 30-day mortality was 4.1%, 90-day was 10.8%, and 1-year was 21.9%. Lower socioeconomic levels were associated with higher risk of waiting >2 days (Adjusted Relative Risk: 1.14) and higher odds for 90-day (Adjusted Odds Ratio: 1.18) and 1-year (Adjusted OR: 1.27) mortality. We found socioeconomic inequities in access to hip replacement and postoperative outcomes. Strengthening the connection between hospital, primary care and rehabilitation services, improving regional monitoring systems and taking into account quality of care in funding health system, may contribute to guarantee uniform levels of healthcare quality in Italy.