Inequalities in hip fracture incidence are greatest in the North of England: regional analysis of the effects of social deprivation on hip fracture incidence across England.

Hip fracture risk varies by geography and by levels of deprivation. We examined the effect of local area-level deprivation on hip fracture incidence across nine regions in England, using 14 years of hospital data, to determine whether inequalities in hip fracture incidence rates vary across geographic regions in England. Sequential annual cross-sectional studies over 14 years. We used English Hospital Episodes Statistics (2001/02-2014/15) to identify hip fractures in adults aged 50+ years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation was used to measure local area deprivation. We calculated age-standardised hip fracture incidence rates per 100,000 population, stratified by gender, geographic region, deprivation quintiles and time-period, using the 2001 English population as the reference population. Using Poisson regression, we calculated age-adjusted incidence rate ratios (IRRs) for hip fracture, stratified as above. Over 14 years, we identified 747,369 hospital admissions with an index hip fracture. Age-standardised hip fracture incidence was highest in the North East for both men and women. In North England (North East, North West and Yorkshire and the Humber), hip fracture incidence was relatively higher in more deprived areas, particularly among men: IRR most vs least deprived quintile 2.06 (95% confidence interval [CI] = 2.00-2.12) in men, 1.62 (95% CI 1.60-1.65) in women. A relationship, albeit less marked, between deprivation and hip fracture incidence was observed among men in the Midlands and South, but with no clear pattern among women. Regional variation in hip fracture incidence exists across England, with the greatest absolute burden of incident hip fractures observed in the North East for both men and women. Across local areas in North England, absolute and relative inequalities in hip fracture incidence were greater than in other regions. Our findings highlight the need for improved fracture prevention programmes that aim to reduce regional and social inequalities in hip fracture incidence.

Bhimjiyani A ，Neuburger J ，Jones T ，Ben-Shlomo Y ，Gregson CL ... -  《-》

The effect of social deprivation on hip fracture incidence in England has not changed over 14 years: an analysis of the English Hospital Episodes Statistics (2001-2015).

Bhimjiyani A ，Neuburger J ，Jones T ，Ben-Shlomo Y ，Gregson CL ... -  《-》

Social deprivation predicts adverse health outcomes after hospital admission with hip fracture in England.

Patel R ，Bhimjiyani A ，Ben-Shlomo Y ，Gregson CL ... -  《-》

How does deprivation influence secondary care costs after hip fracture?

Glynn J ，Hollingworth W ，Bhimjiyani A ，Ben-Shlomo Y ，Gregson CL ... -  《-》

Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Bill & Melinda Gates Foundation and Public Health England.

Newton JN ，Briggs AD ，Murray CJ ，Dicker D ，Foreman KJ ，Wang H ，Naghavi M ，Forouzanfar MH ，Ohno SL ，Barber RM ，Vos T ，Stanaway JD ，Schmidt JC ，Hughes AJ ，Fay DF ，Ecob R ，Gresser C ，McKee M ，Rutter H ，Abubakar I ，Ali R ，Anderson HR ，Banerjee A ，Bennett DA ，Bernabé E ，Bhui KS ，Biryukov SM ，Bourne RR ，Brayne CE ，Bruce NG ，Brugha TS ，Burch M ，Capewell S ，Casey D ，Chowdhury R ，Coates MM ，Cooper C ，Critchley JA ，Dargan PI ，Dherani MK ，Elliott P ，Ezzati M ，Fenton KA ，Fraser MS ，Fürst T ，Greaves F ，Green MA ，Gunnell DJ ，Hannigan BM ，Hay RJ ，Hay SI ，Hemingway H ，Larson HJ ，Looker KJ ，Lunevicius R ，Lyons RA ，Marcenes W ，Mason-Jones AJ ，Matthews FE ，Moller H ，Murdoch ME ，Newton CR ，Pearce N ，Piel FB ，Pope D ，Rahimi K ，Rodriguez A ，Scarborough P ，Schumacher AE ，Shiue I ，Smeeth L ，Tedstone A ，Valabhji J ，Williams HC ，Wolfe CD ，Woolf AD ，Davis AC ... -  《-》