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Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis

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Abstract

Summary

We investigated sex- and age-specific associations between income and fractures at the hip, humerus, spine, and forearm in adults aged ≥50 years. Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women.

Introduction

Associations between income and hip fractures are contested, even less is known about other fracture sites. We investigated sex- and age-specific associations between income and major osteoporotic fractures (MOF) at the hip, humerus, spine, and forearm.

Methods

Incident fractures were identified from administrative health data for adults aged ≥50 years in Manitoba, Canada, 2000–2007. Mean neighborhood (postal code area) annual household incomes were extracted from 2006 census files and categorized into quintiles. We calculated age-adjusted and age-specific sex-stratified fracture incidence across income quintiles. We estimated relative risks (RR) and 95 % CI for income quintile 1 (Q1, lowest income) vs. income quintile 5 (Q5) and tested the linear trend across quintiles.

Results

We identified 15,094 incident fractures (4736 hip, 3012 humerus, 1979 spine, and 5367 forearm) in 2718 men and 6786 women. For males, the RR of fracture for the lowest vs. highest income quintile was 1.63 (95 % CI 1.42–1.87) and the negative trend was statistically significant (p < 0.0001); individual skeletal sites showed similar associations. For females, the RR of fracture for the lowest vs. highest income quintile was 1.14 (95 % CI 1.01–1.28), with a statistically significant negative trend (p = 0.0291); however, the only skeletal site associated with income in women was the forearm (Q1 vs. Q5 RR 1.09, 95 % CI 1.01–1.28).

Conclusions

Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. For men, these effect sizes seem large enough to warrant public health concern.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy (MCHP) for use of data contained in the Population Health Research Data Repository (HIPC project number 2008/2009-16). The results and conclusions are those of the authors, and no official endorsement by the MCHP, Manitoba Health, or other data providers is intended or should be inferred. This project was funded through a research grant from Amgen Canada Ltd. The funding source had no access to the data prior to publication, no input into the writing of the manuscript, and no input in the decision to publish the results. SL Brennan was supported by a National Health and Medical Research Council (NHMRC) of Australia Early Career Fellowship (GNT1012472). SN Morin is chercheur-boursier des Fonds de Recherche du Québec en Santé. LM Lix is supported by a Manitoba Health Research Chair. SR Majumdar holds the Endowed Chair in Patient Health Management (Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta) and receives salary support as a Health Scholar of the Alberta Heritage Foundation for Medical Research and Alberta Innovates-Health Solutions.

Conflicts of interest

Suzanne N. Morin is a consultant to Amgen, Eli Lilly, and Merck and a speaker bureau to Amgen and Eli Lilly. She received a research grant from Amgen and Merck. William D. Leslie is a speaker bureau to Amgen, Eli Lilly, and Novartis. He received research grants from Amgen and Genzyme. Sharon L. Brennan, Lin Yan, Lisa M. Lix, and Sumit Majumdar have no conflicts to declare.

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Authors and Affiliations

  1. School of Medicine, Deakin University, Geelong, Australia

    S. L. Brennan

  2. NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, 176 Furlong Road, St. Albans, Melbourne, Australia

    S. L. Brennan

  3. Australian Institute for Musculoskeletal Sciences, 176 Furlong Road, St. Albans, Melbourne, Australia

    S. L. Brennan

  4. Department of Medicine, University of Manitoba, Winnipeg, Canada

    L. Yan & W. D. Leslie

  5. Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, R3E 0W3, Canada

    L. M. Lix

  6. Department of Medicine, McGill University, Montreal, Canada

    S. N. Morin

  7. Department of Medicine, University of Alberta, Edmonton, Canada

    S. R. Majumdar

  8. Department of Medicine (C5121), St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada

    W. D. Leslie

Authors
  1. S. L. Brennan
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  2. L. Yan
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  3. L. M. Lix
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  4. S. N. Morin
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  5. S. R. Majumdar
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  6. W. D. Leslie
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Corresponding author

Correspondence to W. D. Leslie.

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Brennan, S.L., Yan, L., Lix, L.M. et al. Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis. Osteoporos Int 26, 59–65 (2015). https://doi.org/10.1007/s00198-014-2914-z

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  • DOI: https://doi.org/10.1007/s00198-014-2914-z

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