Hip fractures among the elderly: personal and contextual social factors that matter

There is evidence of independent neighborhood effects on the risk of hip fracture among the elderly. This study builds on earlier investigations and measures the crude and adjusted effects of individual personal- and area-based social attributes on hip fracture.

The study is cross-sectional and register-based, and covers all people aged 65 or older living in the Stockholm metropolitan area during 1993 to 1995. It combines individual data from hospital inpatient registers, population data from census records, and area-based (parish) data from the Stockholm County's registers. Marital status (married or not), country of birth (three categories), and two area-based compositional indexes (social status and economic deprivation, each split into three levels) were considered. Both age adjusted odds ratios and odds adjusted for all other variables were compiled.

The age adjusted effects of individual marital status, country of birth, and area-based social status are considerable and not much affected by the other exposures, to the detriment of married men and women, Swedish-born men and women, and those men and women living in parishes characterized by average and high social status. By contrast, after adjustment, the odds of men and women living in average and high socioeconomic deprivation lose significance.

The attributes of both people and places may contribute to a better understanding of the occurrence of hip fractures among the elderly. The effects of individual marital status, country of birth, and social status of the living area are noticeably robust.