• Nicole Huang, Laura A Hatfield, Saeed Al-Azazi, Pieter Bakx, Amitava Banerjee, Nitzan Burrack, Yu-Chin Chen, Christina Fu, Carlos Godoy Junior, Renaud Heine, Dennis T Ko, Lisa M Lix, Victor Novack, Laura Pasea, Feng Qiu, Bheeshma Ravi, Therese A Stukel, GrootCarin Uyl-deCUErasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands., Peter Cram, and Bruce E Landon.
• Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan. syhuang@nycu.edu.tw.
• J Gen Intern Med. 2024 Dec 20.

BackgroundThere is a perception that income-based disparities are present in most countries but may differ in magnitude. However, there are few international comparisons that describe income-based disparities across countries and none that focus on hip fractures.ObjectiveTo compare treatment patterns and outcomes of high- and low-income older adults hospitalized with hip fracture across six high-income countries.DesignRetrospective serial cross-sectional cohort study.ParticipantsAdults aged ≥ 66 years hospitalized with hip fracture from 2013 to 2019 in Canada, England, Israel, the Netherlands, Taiwan, and the USA using population-representative patient-level administrative data.Main MeasuresOlder adults in the top and bottom income quintiles within countries were compared on 30-day and 1-year mortality, treatment approaches, hospital length of stay (LOS), 30-day readmission rates, time to surgery, and discharge disposition.Key ResultsAnnual age- and sex-standardized incidence rates of hip fracture were higher for low- than for high-income populations in all countries except in the USA. In all countries, adjusted 1-year mortality was lower for high-income than low-income patients, with the largest difference in Israel (- 10.0 percentage points [95% confidence interval [CI], - 15.2 to - 4.8 percentage points]). Across countries, utilization of total hip arthroplasty was 0.1 (95% CI, 0.0-0.2 percentage points) to 6.9 percentage points (95% CI, 4.6-9.2 percentage points) higher among high- vs. low-income populations. With few exceptions, LOS, adjusted 30-day readmission rate, and time to surgery were shorter and lower for high-income patients.ConclusionsIncome-based disparities in treatments and outcomes for older adults hospitalized for hip fractures differed in magnitude, but were present in all six high-income countries. Defying our expectations, the USA did not have consistently larger disparities than other countries suggesting that the impacts of poverty exist in vastly different healthcare systems and transcend geopolitical borders.© 2024. The Author(s).

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