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Int. J. Environ. Res. Public Health 2018, 15(2), 352; https://doi.org/10.3390/ijerph15020352

Socioeconomic Inequality in One-Year Mortality of Elderly People with Hip Fracture in Taiwan

1
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
2
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
3
Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
4
Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
5
Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan
*
Author to whom correspondence should be addressed.
Received: 21 December 2017 / Revised: 26 January 2018 / Accepted: 12 February 2018 / Published: 16 February 2018
(This article belongs to the Section Health Economics)
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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. View Full-Text
Keywords: hip fracture; mortality; socioeconomic status; urbanization; health inequality hip fracture; mortality; socioeconomic status; urbanization; health inequality
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Hsu, I.-L.; Chang, C.-M.; Yang, D.-C.; Chang, Y.-H.; Li, C.-C.; Hu, S.C.; Li, C.-Y. Socioeconomic Inequality in One-Year Mortality of Elderly People with Hip Fracture in Taiwan. Int. J. Environ. Res. Public Health 2018, 15, 352.

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