Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2023

01-12-2023 | Mood Disorders | Original Article

Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study

Authors: Lizheng Xu, Mingsheng Chen, Ke Peng, Mickael Hiligsmann, Stephen Jan, Lei Si

Published in: Archives of Osteoporosis | Issue 1/2023

Login to get access

Abstract

Summary

This study analyzed the impact of hip fractures on people’s health-related quality of life and its socio-demographic disparities in China.

Purpose

Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants’ HRQoL exist in China.

Methods

Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL.

Results

A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05).

Conclusion

Hip fracture significantly affects people’s HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.
Appendix
Available only for authorised users
Literature
1.
Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–2256PubMedPubMedCentral
2.
Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136PubMedPubMedCentral
3.
Si L, Winzenberg TM, Chen M, Jiang Q, Palmer AJ (2015) Residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women. Curr Med Res Opin 31:1149–1156PubMed
4.
Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ (2015) Projection of osteoporosis-related fractures and costs in China: 2010–2050. Osteoporos Int 26:1929–1937PubMed
5.
Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R (2019) Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res 14:203PubMedPubMedCentral
6.
Katsoulis M, Benetou V, Karapetyan T et al (2017) Excess mortality after hip fracture in elderly persons from Europe and the USA: the chances project. J Intern Med 281:300–310PubMed
7.
Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMed
8.
Svedbom A, Borgstöm F, Hernlund E et al (2018) Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 29:557–566PubMed
9.
van de Ree CLP, Landers MJF, Kruithof N, de Munter L, Slaets JPJ, Gosens T, de Jongh MAC (2019) Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study. BMJ Open 9:e025941PubMedPubMedCentral
10.
Gjertsen JE, Baste V, Fevang JM, Furnes O, Engesæter LB (2016) Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord 17:265PubMedPubMedCentral
11.
Si L, Winzenberg TM, de Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25:1987–1997PubMed
12.
Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J (2016) Quality of life after hip fracture in the elderly: A systematic literature review. Injury 47:1369–1382PubMed
13.
Gold T, Williams SA, Weiss RJ, Wang Y, Watkins C, Carroll J, Middleton C, Silverman S (2019) Impact of fractures on quality of life in patients with osteoporosis: a US cross-sectional survey. J Drug Assess 8:175–183PubMedPubMedCentral
14.
Shyu YI, Chen MC, Liang J, Lu JF, Wu CC, Su JY (2004) Changes in quality of life among elderly patients with hip fracture in Taiwan. Osteoporos Int 15:95–102PubMed
15.
Koh DTS, Chen JY, Yew AKS, Chong HC, Hao Y, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ (2019) Functional outcome and quality of life in patients with hip fracture after total knee arthroplasty. J Orthop Surg (Hong Kong) 27:2309499019852338PubMed
16.
Miravitlles M, Naberan K, Cantoni J, Azpeitia A (2011) Socioeconomic status and health-related quality of life of patients with chronic obstructive pulmonary disease. Respiration 82:402–408PubMed
17.
Moss JL, Pinto CN, Mama SK, Rincon M, Kent EE, Yu M, Cronin KA (2021) Rural-urban differences in health-related quality of life: patterns for cancer survivors compared to other older adults. Qual Life Res 30:1131–1143PubMed
18.
Zhao Y, Hu Y, Smith JP, Strauss J, Yang G (2014) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 43:61–68PubMed
19.
Parsons N, Griffin XL, Achten J, Costa ML (2014) Outcome assessment after hip fracture: is EQ-5D the answer? Bone Joint Res 3:69–75PubMedPubMedCentral
20.
Balestroni G, Bertolotti G (2012) EuroQol-5D (EQ-5D): an instrument for measuring quality of life. Monaldi Arch Chest Dis 78:155–159PubMed
21.
(2002) Occupational therapy practice framework: domain and process. Am J Occup Ther 56(6):609–639
22.
Björgvinsson T, Kertz SJ, Bigda-Peyton JS, McCoy KL, Aderka IM (2013) Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment 20:429–436PubMed
23.
Abimanyi-Ochom J, Watts JJ, Borgström F et al (2015) Changes in quality of life associated with fragility fractures: Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS). Osteoporos Int 26:1781–1790PubMedPubMedCentral
24.
Zhao H, Wei P, Feng Y (2022) Association between frailty and clinical outcomes and quality of life in older adults following hip fracture surgery: a retrospective cohort study. Anesth Analg 134(5):1035–1042
25.
Chiu MH, Hwang HF, Lee HD, Chien DK, Chen CY, Lin MR (2012) Effect of fracture type on health-related quality of life among older women in Taiwan. Arch Phys Med Rehabil 93:512–519PubMed
26.
Guirant L, Carlos F, Curiel D, Kanis JA, Borgström F, Svedbom A, Clark P (2018) Health-related quality of life during the first year after a hip fracture: results of the Mexican arm of the International Cost and Utility Related to Osteoporotic Fractures Study (MexICUROS). Osteoporos Int 29:1147–1154PubMed
27.
Zhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, Cowling TE, Sum G, Qin VM, Lee JT (2020) Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health 8:e840–e849PubMedPubMedCentral
28.
Gu J, Chao J, Chen W, Xu H, Zhang R, He T, Deng L (2018) Multimorbidity and health-related quality of life among the community-dwelling elderly: A longitudinal study. Arch Gerontol Geriatr 74:133–140PubMed
29.
Amarilla-Donoso FJ, López-Espuela F, Roncero-Martín R, Leal-Hernandez O, Puerto-Parejo LM, Aliaga-Vera I, Toribio-Felipe R, Lavado-García JM (2020) Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes 18:71PubMedPubMedCentral
30.
Amarilla-Donoso FJ, Roncero-Martin R, Lavado-Garcia JM, Toribio-Felipe R, Moran-Garcia JM, Lopez-Espuela F (2020) Quality of life after hip fracture: a 12-month prospective study. PeerJ 8:e9215PubMedPubMedCentral
31.
Milte R, Crotty M, Miller MD, Whitehead C, Ratcliffe J (2018) Quality of life in older adults following a hip fracture: an empirical comparison of the ICECAP-O and the EQ-5D-3 L instruments. Health Qual Life Outcomes 16:173PubMedPubMedCentral
32.
Ekström W, Al-Ani AN, Sääf M, Cederholm T, Ponzer S, Hedström M (2013) Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture–a 2 year follow-up study. Injury 44:769–775PubMed
33.
Elboim-Gabyzon M, Andrawus Najjar S, Shtarker H (2019) Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial. Clin Interv Aging 14:1841–1850PubMedPubMedCentral
34.
Herrick C, Steger-May K, Sinacore DR, Brown M, Schechtman KB, Binder EF (2004) Persistent pain in frail older adults after hip fracture repair. J Am Geriatr Soc 52:2062–2068PubMed
35.
Solbakken SM, Magnus JH, Meyer HE et al (2019) Urban-Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study. JBMR Plus 3:e10236PubMedPubMedCentral
36.
Sanzone AG (2016) Current Challenges in Pain Management in Hip Fracture Patients. J Orthop Trauma 30(Suppl 1):S1-5PubMed
37.
Marques A, Lourenço Ó, da Silva JA (2015) The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int 26:2623–2630PubMed
38.
Tchicaya A, Lorentz N (2016) Socioeconomic inequalities in health-related quality of life between men and women, 5 years after a coronary angiography. Health Qual Life Outcomes 14:165PubMedPubMedCentral
39.
JieAnNaMu XuX, You H, Gu H, Gu J, Li X, Cui N, Kou Y (2020) Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet. China BMC Public Health 20:630PubMed
40.
Valentin G, Pedersen SE, Christensen R, Friis K, Nielsen CP, Bhimjiyani A, Gregson CL, Langdahl BL (2020) Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies. Osteoporos Int 31:31–42PubMed
41.
Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M (2019) Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev 53:100903PubMed
42.
Fisher K, Griffith L, Gruneir A, Panjwani D, Gandhi S, Sheng LL, Gafni A, Chris P, Markle-Reid M, Ploeg J (2016) Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: A population-based study in Ontario, Canada. Diabetes Res Clin Pract 122:113–123PubMed
43.
González-Zabaleta J, Pita-Fernandez S, Seoane-Pillado T, López-Calviño B, Gonzalez-Zabaleta JL (2016) Comorbidity as a predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int 16:561–569PubMed
44.
Hou Y, Wu Q, Zhang D, Jin X, Wu W, Wang X (2020) The differences in self-perceptions of aging, health-related quality of life and their association between urban and rural Chinese older hypertensive patients. Health Qual Life Outcomes 18:154PubMedPubMedCentral
45.
Zhou Z, Zhou Z, Gao J, Lai S, Chen G (2018) Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province. PLoS One 13:e0204118PubMedPubMedCentral
46.
Zhao Y, Xu X, Dupre ME, Xie Q, Qiu L, Gu D (2020) Individual-level factors attributable to urban-rural disparity in mortality among older adults in China. BMC Public Health 20:1472PubMedPubMedCentral
47.
Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna FS, Wluka AE (2010) The association between urban or rural locality and hip fracture in community-based adults: a systematic review. J Epidemiol Community Health 64:656–665PubMed
48.
Weller I, Wai EK, Jaglal S, Kreder HJ (2005) The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br 87:361–366PubMed
49.
Miller BJ, Cai X, Cram P (2012) Mortality rates are similar after hip fractures for rural and urban patients. Clin Orthop Relat Res 470:1763–1770PubMed
50.
Lawson A, Tan AC, Naylor J, Harris IA (2020) Is retrospective assessment of health-related quality of life valid? BMC Musculoskelet Disord 21:415PubMedPubMedCentral
51.
Wang L, Liu W (2022) Effects of Family Doctor Contract Services on the Health-Related Quality of Life Among Individuals With Diabetes in China: Evidence From the CHARLS. Front Public Health 10:865653PubMedPubMedCentral
52.
Kim JH, Park EC (2015) Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health 15:783PubMedPubMedCentral
53.
Li C, Tang C, Wang H (2019) Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China. Int J Equity Health 18:166PubMedPubMedCentral
54.
Egede LE (2006) Disease-focused or integrated treatment: diabetes and depression. Med Clin North Am 90:627–646PubMed
55.
Arcury TA, Preisser JS, Gesler WM, Powers JM (2005) Access to transportation and health care utilization in a rural region. J Rural Health 21:31–38PubMed
56.
Chen Y, Li X, Jing G, Pan B, Ge L, Bing Z, Yang K, Han X (2020) Health education interventions for older adults with hypertension: A systematic review and meta-analysis. Public Health Nurs 37:461–469PubMed
57.
Si L, Winzenberg TM, Chen M, Jiang Q, Neil A, Palmer AJ (2016) Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study. Osteoporos Int 27:2259–2269PubMed
Metadata
Title
Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study
Authors
Lizheng Xu
Mingsheng Chen
Ke Peng
Mickael Hiligsmann
Stephen Jan
Lei Si
Publication date
01-12-2023
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2023
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-023-01220-2

Other articles of this Issue 1/2023

Archives of Osteoporosis 1/2023 Go to the issue

Original Article

Rapid trabecular bone growth in puberty associated with stiffer arteries in adulthood – longitudinal study on healthy young males

Original Article

Treatment rates and healthcare costs of patients with fragility fracture by site of care: a real-world data analysis

Original Article

Bone health is improving over time: data from Framingham cohorts

Original Article

Prevalence and risk factors of osteoporosis and osteopenia among residents in Hubei province, China

Original Article

Association between traffic-related air pollution and osteoporotic fracture hospitalizations in inland and coastal areas: evidences from the central areas of two cities in Shandong Province, China

Original Article

Risk factors for the comorbidity of osteoporosis/osteopenia and kidney stones: a cross-sectional study