The Effect Of Social Deprivation On Distal Radius Fracture Incidence And Treatment

Aim: Socioeconomic deprivation is known to be associated with many types of fracture but the reasons for this are not clearly understood. The primary aim of this thesis is to investigate if deprivation is associated with distal radius fracture and does it influence distal radius fracture treatment. Methods: Regression modelling techniques are used to analyse four years of Leicestershire emergency department data (n=4278) and national Hospital Episodes Statistics data (n=59,315) from a similar period. Radiographic analysis and a prospective survey is carried out to identify factors responsible for the effects of deprivation on fracture incidence. Systematic review and meta-analysis is performed to quantify the risk of hip fracture after distal radius fracture. Results: Deprivation was strongly associated with distal radius fracture in the whole population studied. Deprived patients sustained their injuries at an earlier age. The influence of deprivation was larger in white men. Incidence rate in the least deprived quintile was a third of that in the most deprived for white men and almost half for white women. Age 50 years and over and male gender was an independent risk factor for distal radius fracture in all ethnicities. Falls risk was associated with increasing deprivation. Significant variation is identified between hospital trusts treating distal radius fractures with a higher fixation rate seen in trusts with a smaller population. Deprivation was not related to any of the parameters of hospital care studied. Discussion: Poverty is rising which will lead to higher levels of social deprivation and an increase in distal radius fracture rate. Fracture prevention strategies are required to combat this rise. Knowing which patients are at highest risk allows interventions to be efficiently targeted. Resources should be targeted to those at-risk patients from deprived areas and preventative strategies put in place.