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Variation in UK fracture incidence by age, sex, geography, ethnicity,
socioeconomic status and time: Results from the UK CPRD
Elizabeth M Curtis, Robert van der Velde, Rebecca J Moon, Joop P W van den Bergh, Piet Geusens, Frank de Vries, Tjeerd P van Staa,
Cyrus Cooper*, Nicholas C Harvey**CC and NCH are joint senior author
Presenter Disclosure Information:This speaker has no conflicts of interest
Background
• Economic and personal costs of osteoporotic fracture substantial– 37bn Euros, 1.18m QALYs lost annually1
• Large variability in fracture incidence worldwide – differences according to geography, ethnicity, socioeconomics2
• Last study in UK published 20013 – current study 1988-20124
1. Hernlund et al, Arch Osteoporos, 8 (2013) 136.2. Kanis et al, Osteoporos Int. 23 (2012) 2239-2256.
3. Van Staa et al, Bone 29 (2001) 517-522.4. Curtis EM et al., Bone 87 (2016) 19-26
Aim
• To describe the incidence of fracture in the UK by age, sex, fracture site, geographic location, socioeconomic status, ethnicity and calendar time
• UK Clinical Practice Research Datalink - anonymised electronic patient records collected by General Practitioners
• Approximately 6.9% of the UK population, with representative demographics
• Data stored as READ codes referenced to ICD-9, validated fracture outcomes4; standardised ethnicity5
• All individuals aged >18 yrs with a fracture recorded on GP records between 1988-2012 included in analysis
• Incidence calculated (per 10,000 py) by age, sex, fracture site, ethnicity, socioeconomic status, geographic location, calendar period
https://www.cprd.com/home/4. Van Staa, Pharmacoepidemiol Drug Saf. 9 (2000) 359-3665. Mathur et al, J Public Health (Oxf). 36 (2014) 684-692
Methods
Age- and sex-specific fracture incidence rate at any site among UK adults, 1988-2012
25 30 35 40 45 50 55 60 65 70 75 80 85 90 90+0
50
100
150
200
250
300
350
400
450
male
female
Age category
Incid
ence
/10,
000
pers
on y
ears
Men Women
Age group No. of cases Rate per 10,000 py No. of cases Rate per 10,000 py18-49 years 121219 94.8 78265 54.350+ years 75331 71.8 185267 155.4
Curtis EM et al., Bone 87 (2016) 19-26
Total follow-up time:Men = 23,285,904 pyWomen = 26,342,685 py
Regional variation in fragility fracture incidence in men and women aged 50+ years within the UK
Relative rates of fracture are displayed in comparison to London
Differences keeping with patterns of socioeconomic status, rural population, possibly ethnicity differences, falls, vitamin D deficiency
Fragility fracture: spine, hip, wrist, rib, pelvis, and humerus
Curtis EM et al., Bone 87 (2016) 19-26
Socioeconomic status and fracture incidence in UK men and women aged 50+ years
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1 2 3 4 5
Rela
tive
rate
of f
ract
ure
Index of Multiple Deprivation Category
Fragility
Men
Women
IMD 5 = most deprivedCurtis EM et al., Bone 87 (2016) 19-26
RR fracture hip fracture males category 5= 1.3
Possible causes: smoking, alcohol, diet, prevalence of obesity, influence of manual work may account for sex differences
Incidence of fragility and femur/hip by ethnicity in UK men and women aged 50+ years
Men aged 50+ yrs Women aged 50+ yrsFracture
type EthnicityNumber of
casesRate per
10,000 pyNumber of
casesRate per
10,000 py
Fragility Black 88 15.75 149 22.26 Mixed 22 17.37 77 50.12 South Asian 289 26.85 491 44.46 Other/ unknown 20883 36.19 59824 97.23 White 25285 41.74 71081 104.03
Hip/femur Black 26 4.57 44 6.45 Mixed 4 3.07 14 8.77 South Asian 68 6.15 115 10.03 Other/ unknown 6767 11.13 22390 33.52 White 7901 12.27 24520 32.61
Curtis EM et al., Bone 87 (2016) 19-26
Incidence of fragility fractures in UK men and women, 1990-2012
+
+
+
+
-
+
--
+
Conclusions
• Up to date age- and sex-specific fractures rates for the UK presented
• Marked variation in rates by geographic location, socioeconomic status and ethnicity
• Reasons for differences likely multiple (e.g. diet, lifestyle, adiposity, BMD, bone geometry)
• In contrast to the plateau/decrease in hip fracture rates previously shown we observed an increasing rate in hip fractures in men, and vertebral fractures in both men and women
• Potential implications for healthcare planning in UK and elsewhere
Acknowledgements
Supervisors:
Professor Nicholas Harvey
Professor Cyrus CooperCo-authors:
Dr R van der Velde
Dr R Moon
Dr J van den Bergh
Dr C Wyers
Dr P Geusens
Dr F de Vries
Prof T van Staa
Variation in UK fracture incidence by age, sex, geography, ethnicity,
socioeconomic status and time: Results from the UK CPRD
Elizabeth M Curtis, Robert van der Velde, Rebecca J Moon, Joop P W van den Bergh, Piet Geusens, Frank de Vries, Tjeerd P van Staa,
Cyrus Cooper*, Nicholas C Harvey**CC and NCH are joint senior author
Presenter Disclosure Information:This speaker has no conflicts of interest