Abstract
Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care and cost. Taiwan launched its universal health insurance coverage in 1995, which largely removes financial barriers to health care. This study aims to investigate whether socioeconomic inequality in one-year mortality exists among Taiwanese elderly people. This population-based cohort study included 193,158 elderly patients (≥65 years) admitted for hip fracture between 2000 and 2012. With over a one-year follow-up, 10.52% of the participants died from all causes. The mortality rate was low in the northern part of Taiwan and in urban and high-family-income areas. Multiple Poisson regression models further suggested that the level of >Q1–Q3 and >Q3–Max showed significantly reduced odds ratio of one-year mortality at 0.90 (95% confidence interval (CI), 0.87–0.93) and 0.77 (95% CI, 0.74–0.81), respectively, compared with that of the lowest family income level (i.e., Min.–Q1). Despite a monotonic decline in overall one-year mortality during the study period, socioeconomic inequality in one-year mortality rate remained evident. The annual percentage change in one-year mortality was higher (−2.86) in elderly people from families with high income (>Q3–Max.) than that for elderly patients from family with low income (Min.–Q1, −1.94). Accessibility, rather than affordability, to health care for hip fracture is probably responsible for the observed socioeconomic inequality.
Highlights
Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care, and cost [1,2]
We aimed to examine the secular trend in one-year mortality during the implementation of the National Health Insurance (NHI) program and assess whether the risk of one-year mortality still shows a socioeconomic disparity in Taiwan
To assess the socioeconomic inequality in one-year mortality caused by hip fracture across the study period, we presented the secular trends for one-year mortality rate in relation to overall and median family annual income level
Summary
Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care, and cost [1,2]. The majority of patients who undergo surgical treatment may survive, the proportion of those not completely recuperating to their previous levels of independence remains high [3]. Given the remarkable increase in the elderly population in many developed nations, hip fractures may exponentially increase in frequency over the several decades as a result of increased life expectancy and population growth. The economic influence of hip fractures may be large; this influence includes mortality and direct cost of medical cares and certain indirect economic burden, such as reduced quality of life, loss of independence, and inability to work [4]. Public Health 2018, 15, 352; doi:10.3390/ijerph15020352 www.mdpi.com/journal/ijerph
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