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. 2025 Nov 15:17:953-965.
doi: 10.2147/CLEP.S540994. eCollection 2025.

The Association Between Socioeconomic Position and Infection Risk After Hip Fracture Surgery: A Nationwide Cohort Study of 54,853 Patients

Nadia Roldsgaard Gadgaard  1 , Claus Varnum  2   3 , Rob Nelissen  4 , Christina Vandenbroucke-Grauls  1   5 , Henrik Toft Sørensen  1 , Alma Becic Pedersen  1
Affiliations

The Association Between Socioeconomic Position and Infection Risk After Hip Fracture Surgery: A Nationwide Cohort Study of 54,853 Patients

Nadia Roldsgaard Gadgaard et al. Clin Epidemiol. .

Abstract

Purpose: We examined the association between socioeconomic position (SEP) and risk of any infection after surgery for hip fracture, and whether markers of poor health modify this.

Methods: Individual-level data on SEP markers (education, liquid assets, marital status, and cohabitation) were obtained from Danish registries for hip fracture patients undergoing surgery (2010-2018). We computed cumulative incidences of any hospital-treated infection within one month after surgery. Using Cox regression we estimated adjusted hazard ratios (aHRs) with 95% confidence intervals. Analyses were stratified by comorbidity clusters based on latent class analysis, body mass index (BMI), pre-fracture mobility, and residence type.

Results: The incidences of infection were: 17% for low vs 16% for high education (aHR 1.10, 1.02-1.18), 19% for low vs 16% for high liquid assets (aHR 1.21, 1.15-1.28), 18% for divorced vs 16% for married (aHR 1.24, 1.15-1.32), and 18% for living alone vs 15% for cohabiting (aHR 1.16, 1.06-1.28). The incidence of infection was highest among patients with diabetic-renal comorbidity, underweight, poor mobility, or nursing home residency. The magnitude and direction of associations were modified by comorbidity clusters, BMI, mobility, and residence type.

Conclusion: We observed socioeconomic inequalities in 30-day risk of infection after hip fracture surgery. Health modified the observed inequalities but could not fully explain them.

Keywords: (MeSH); Epidemiology; Hip fractures; Infections; Low Socioeconomic Status.

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Conflict of interest statement

CV received travel expenses from Stryker with no relevance to the present study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Age, sex, comorbidity-cluster, body mass index (BMI), pre-fracture mobility and residence distributions by markers of socioeconomic position.
Figure 2
Figure 2
Plots of cumulative incidences of hospital-treated infection over time up to 30 days after date of surgery by (A) education, (B) liquid assets, (C) marital status, and (D) living arrangement.
Figure 3
Figure 3
Forest plots of adjusted hazard ratios (aHRs) for (A) hospital-treated infection or (B) community-treated infection by socioeconomic markers: Education adjusted by age, sex, and surgery year. Liquid assets adjusted by age, sex, surgery year, education, marital status, and comorbidity cluster. Marital status adjusted by age, sex, surgery year, and education. Living arrangements adjusted by age, sex, surgery year, education, marital status, comorbidity cluster, liquid assets, body mass index, and pre-fracture mobility.
Figure 4
Figure 4
Plots of adjusted hazard ratios for hospital-treated infection stratified by comorbidity clusters, body mass index, pre-fracture mobility, and residence type. According to (A) education adjusted by age, sex, and surgery year; (B) liquid assets adjusted by age, sex, surgery year, education, marital status, and comorbidity cluster; (C) marital status adjusted by age, sex, surgery year, and education; and (D) living arrangement adjusted by age, sex, surgery year, education, marital status, comorbidity cluster, liquid assets, body mass index, and pre-fracture mobility.
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