Socioeconomic aspects of fractures within universal public healthcare: A nationwide case-control study from Denmark

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Abstract
Aims: To investigate the effects of income and other socioeconomic variables on fracture risk adjusted for disease-related confounders as fractures are a major public health problem. Methods: Case-control study where all subjects in Denmark with a fracture during the year 2000 (n=124,655) served as cases. From the general population three age- and gender-matched subjects were selected as controls (n=373,962). Adjustment were made for income, living with someone vs. living alone, having a job vs. being out of work, education, comorbidity (Charlson index), number of bed days in hospital, number of contacts with general practitioner, use of corticosteroids, prior fracture, and alcoholism. Results: Income was not associated with fracture risk on adjustment for the other covariates. Living with someone was associated with a decreased risk of any fracture in all ages. A higher level of education was associated with a decreased fracture risk in the age groups<60 years, but an increased fracture risk among subjects≥60 years. Being at work was associated with a decreased hip fracture risk among subjects≥40 years. Alcoholism and a prior fracture were significant predictors of fracture in all age groups. Conclusions: Income does not predict fracture risk in Denmark after adjustment for other social and comorbidity variables. This may signal neutralization of the effect by socioeconomic compensation or that income was the product of underlying socioeconomic variables.

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