The socioeconomic impact of a femoral neck fracture on patients aged 18-50: A population-based study.

Abstract

By linking health and census data, the objective of this study was to determine the effect of a femoral neck fracture on the household income of non-elderly patients. All individuals aged 18-50 who underwent internal fixation for a femoral neck fracture during the years 2006-2012 in the Canadian Province of British Columbia were included in the study. Patient-level hospital data was linked with patient's after-tax household income decile, as estimated by Statistics Canada Postal Code Conversion Files. The primary endpoint was a decline of ≥2 income deciles following the index fracture. Kaplan-Meier analysis was performed to estimate the probability of income decline during the study period. A Cox regression model was used to study the association between a ≥2 income decline and patient age, sex, reoperation, and pre-injury income decile. Of the 391 femoral neck fracture patients included, the majority of patients were male (61.6%), with a median age of 43 years (IQR: 35-48), and a pre-injury median income in the fifth decile (IQR: decile 3-8). 27.0% of patients sustained a decline of ≥2 income deciles during the study period, with 16.3% declining ≥2 income deciles within 2-years of injury. A pre-injury household income in the top 4 deciles (mean of deciles: $57,000-170,500) was associated with an increased likelihood of a ≥2 drop in household income (HR: 1.38, 95% CI: 1.06-1.79, p = 0.02). Over a quarter of the femoral neck fracture patients in this study sustained a decline of ≥2 deciles in their household income following their injury. The income decline was disproportionately absorbed by patients with baseline incomes in the 6^th decile or higher. This suggests that the available incapacity programs are limited in providing income protection to patients with higher incomes.