Bone Abstracts

Background: This study examined whether systematic differences exist in hip fracture care delivery and outcomes in England and Wales by age, sex, ethnicity, and area-level deprivation, after accounting for patient and hospital characteristics.

Methods: We conducted a national cohort study using hospital admission and mortality data from England and Wales linked to the National Hip Fracture Database. The study included patients aged ≥60 years who sustained a hip fracture between 2016 and 2019. Metrics were four Key Performance Indicators (KPIs): orthogeriatric assessment within 72 hours (KPI1), surgery by the day following presentation (KPI2) and NICE recommended surgery (KPI3) with two outcomes: out-of-bed by the day after surgery (KPI4) and 30-day mortality. Differences by age (80 vs ≥80 years), sex (female vs male), ethnicity (White vs non-White), and deprivation (least vs most index of multiple deprivation quintile) were tested using modified Poisson regression adjusted for patient factors including age, sex, deprivation, and ethnicity as appropriate; fracture type, pre-fracture residence and mobility, anaesthetic grade, comorbidity and frailty scores and hospital factors including trauma centre status, hip fracture admission volume, and nation.

Results: 178,595 patients were included in the analysis: mean age 82.7 years and 70.6% female. NICE-compliant surgery was less likely in older patients (adjusted risk difference [RD] 6.02%, 95%CI:5.48%-6.56%; adjusted risk ratio [RR] 1.25, 95%CI:1.22-1.28; N174,730) and men (RD 1.32%, 95%CI:0.83%-1.81%; RR 1.05, 95%CI:1.03-1.07; N174,730) corresponding to 7,149 older patients and 673 men over 3-years. Mortality at 30-days was also higher among older patients (RD 3.22%, 95%CI:2.95%-3.49%; RR 1.65, 95%CI:1.58-1.73; N178,595) and men (RD 4.04%, 95%CI:3.71%-4.37%; RR 1.66, 95%CI:1.60-1.72; N178,595) corresponding to 3,913 older patients and 2,118 men over 3-years. Non-White patients remained less likely to be promptly out-of-bed following surgery (RD 4.32%, 95%CI:1.41%-7.23%; RR 1.21, 95%CI:1.07-1.36; N153,572) compared to White patients.

Conclusion: Hip fracture services appear mostly equitable across deprivation groups. Ethnicity was not recorded in hospital admissions data for 12% of patients, so findings may be subject to selection bias. However, persistent differences by age and sex suggest potential inequities or unmeasured factors affecting care delivery and outcomes. Ongoing monitoring and further understanding of these differences are needed.