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The contributions of First Nations ethnicity, income, and delays in surgery on mortality post-fracture: a population-based analysis

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Abstract

Summary

We examined the independent contributions of First Nations ethnicity and lower income to post-fracture mortality. A similar relative increase in mortality associated with fracture appears to translate into a larger absolute increase in post-fracture mortality for First Nations compared to non-First Nations peoples. Lower income also predicted increased mortality post-fracture.

Introduction

First Nations peoples have a greater risk of mortality than non-First Nations peoples. We examined the independent contributions of First Nations ethnicity and income to mortality post-fracture, and associations with time to surgery post-hip fracture.

Methods

Non-traumatic fracture cases and fracture-free controls were identified from population-based administrative data repositories for Manitoba, Canada (aged ≥50 years). Populations were retrospectively matched for sex, age (within 5 years), First Nations ethnicity, and number of comorbidities. Differences in mortality post-fracture of hip, wrist, or spine, 1996–2004 (population 1, n = 63,081), and the hip, 1987–2002(Population 2, n = 41,211) were examined using Cox proportional hazards regression to model time to death. For hip fracture, logistic regression analyses were used to model the probability of death within 30 days and 1 year.

Results

Population 1: First Nations ethnicity was associated with an increased mortality risk of 30–53 % for each fracture type. Lower income was associated with an increased mortality risk of 18–26 %. Population 2: lower income predicted mortality overall (odds ratio (OR) 1.15, 95 % confidence interval (CI) 1.07–1.23) and for hip fracture cases (OR 1.18, 95%CI 1.05–1.32), as did older age, male sex, diabetes, and >5 comorbidities (all p ≤ 0.01). Higher mortality was associated with pertrochanteric fracture (OR 1.14, 95 % CI 1.03–1.27), or surgery delay of 2–3 days (OR 1.34, 95 % CI 1.18–1.52) or ≥4 days (OR 2.35, 95 % CI 2.07–2.67).

Conclusion

A larger absolute increase in mortality post-fracture was observed for First Nations compared to non-First Nations peoples. Lower income and surgery delay >2 days predicted mortality post-fracture. These data have implications regarding prioritization of healthcare to ensure targeted, timely care for First Nations peoples and/or individuals with lower income.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC project 2000/2001-08). The authors are indebted to the First Nations and Inuit Health Branch, and Aboriginal Affairs and Northern Development Canada, for permission to use the Status Verification System, and to the Health Information Research Committee of the Assembly of Manitoba Chiefs for actively supporting this work. The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, the Assembly of Manitoba Chiefs, or other data providers is intended, or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Funding

This research was funded through an operating grant (ACB-65731) from the Canadian Institutes of Health Research (CIHR). Sharon L. Brennan was funded by a National Health and Medical Research Council (NHMRC) of Australia Early Career Fellowship (no. 1012472). Lisa M Lix was funded by a University of Saskatchewan Centennial Chairs Program.

Conflicts of interest

William D. Leslie received research grants from Merck Frosst Canada, Amgen Pharmaceuticals Canada, and Genzyme Canada; research honoraria and educational grants from Sanofi-Aventis, Procter & Gamble Pharmaceuticals Canada, and Novartis; and has involvement with Advisory Boards for Genzyme Canada, Novartis, and Amgen Pharmaceuticals Canada. Lisa M. Lix and Colleen Metge received research grant from Amgen Pharmaceuticals Canada. All other authors declare no competing interests.

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Leslie, W.D., Brennan, S.L., Prior, H.J. et al. The contributions of First Nations ethnicity, income, and delays in surgery on mortality post-fracture: a population-based analysis. Osteoporos Int 24, 1247–1256 (2013). https://doi.org/10.1007/s00198-012-2099-2

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