How does deprivation influence secondary care costs after hip fracture?
| Autor: | Joel Glynn, Yoav Ben-Shlomo, Arti Bhimjiyani, Celia L Gregson, William Hollingworth |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Deprivation medicine.medical_specialty Inequality Economics Cost Endocrinology Diabetes and Metabolism media_common.quotation_subject Osteoporosis Psychological intervention 030209 endocrinology & metabolism Comorbidity Secondary Care Hip fracture Secondary care 03 medical and health sciences 0302 clinical medicine Health care medicine HEB Humans Hospital Costs media_common business.industry Hip Fractures Health Status Disparities Middle Aged medicine.disease Hospital care England Social Class Orthopedic surgery 030101 anatomy & morphology Inequalities business Demography |
| Zdroj: | Glynn, J D, Hollingworth, W, Bhimjiyani, A, Ben-Shlomo, Y & Gregson, C L 2020, ' How does deprivation influence secondary care costs after hip fracture? ', Osteoporosis International, vol. 2020 . https://doi.org/10.1007/s00198-020-05404-1 |
| ISSN: | 1433-2965 |
| DOI: | 10.1007/s00198-020-05404-1 |
| Popis: | Summary: We studied the association between deprivation and healthcare costs after hip fracture. Hospital costs in the year following hip fracture were £1120 higher for those living in more deprived areas. Most of this difference was explained by preexisting health inequalities which should be targeted to reduce this disparity.Introduction: To quantify differences in hospital costs following hip fracture between those living in higher and lower deprivation areas of England, we investigate pre- and post-fracture variables that explain the association.Methods: We used English Hospital Episodes Statistics linked to the National Hip Fracture Database (April 2011–March 2015) and national mortality data to identify patients admitted with hip fracture aged 60+ years. Hospital care was costed using 2017/2018 national reference costs, by index of multiple deprivation quintile. Three generalised linear model regressions estimated associations between deprivation and costs and the pre- and post-fracture variables that mediate this relationship.Results: Patients from the most deprived areas had higher hospital costs in the year post-fracture (£1,120; 95% CI £993 to £1,247) than those from the least deprived areas. If all patients could have incurred similar costs to those in the least deprived quintile, this would equate to an annual reduction in expenditure of £28.8 million. Pre-fracture characteristics, particularly comorbidities and anaesthetic risk grade, accounted for approximately 50% of the association between deprivation and costs. No evidence was found that post-fracture variables, such as transfer to a residential or nursing home, contributed to the association between deprivation and costs.Conclusions: Socioeconomic inequalities are associated with substantial costs for the NHS after hip fracture. We did not identify post-fracture targets for intervention to reduce the impact of inequalities on post-fracture costs. The case for interventions to reduce comorbid conditions, improve health-related behaviours and prevent falls in deprived areas is clear but challenging to implement. |
| Databáze: | OpenAIRE |
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