Level of education is the socio-economic factor most strongly associated with survival rates after acute hip surgery. This is shown in a Linköping University study of 58,000 people. The results can be used to better identify patients who may need more support after surgery.

“We’re not saying more people should study further. Rather, level of education can be seen as a marker that helps healthcare identify patients who may need additional support, for example in the form of tailored information, rehabilitation and follow-up after hospitalisation,” says Rasmus Åhman, PhD student at Linköping University and physician at Råslätt health centre in Jönköping.

In Sweden, about 17,500 people suffer a hip fracture per year. The average age of those affected is over 80, and with an ageing population, the number of acute hip operations will see an increase in the long term.

Although Swedish health care follows a well-established standard procedure for hip fractures, often fast-tracking surgery, survival rates vary. Researchers at Linköping University and Queen Mary University of London have investigated why.

Using the Swedish register that collects data on surgeries and anaesthesia – SPOR – they have followed about 58,000 people who suffered a hip fracture and had acute surgery. The researchers found that mortality among patients aged 80–84 years was three times as high as the expected mortality in the same age group in the Swedish population, also two years after surgery.

They then examined four different socio-economic factors to see which had the strongest correlation with mortality – level of education, residential area, income and access to home care or nursing homes.

“There’s a link to increased risk of mortality in both the short and long term, based on the individual socio-economic factors we investigated. Above all, it was the level of education that showed the strongest correlation with mortality,” says Rasmus Åhman.

The results also showed that income played a smaller role, while access to home care or nursing homes was more difficult to interpret. And residential area turned out not to play any major role at all.

“Based on our data, there seems to be no clear differences in survival depending on the type of hospital where you had your hip fracture surgery,” says Rasmus Åhman.

Previous studies have shown links between socio-economic factors and mortality, but many have used composite measures rather than individual factors. The studies that have examined education and income separately have identified the two as equivalent. These studies based the income level on taxable income, a measure that does not provide the whole picture, according to Rasmus Åhman, particularly when it comes to an older group who has not worked for a long time.

The Linköping researchers instead looked at a measure called disposable family income, developed by Statistics Sweden. This involves weighing together a large number of income and expenditure items to provide a more comprehensive picture of the individual's financial position.

The fact that level of education was the factor most strongly linked to mortality may, according to Rasmus Åhman, be linked to how an individual can get through the long process that an operation entails.

“There’s a concept called health literacy, which we think may relate closely to level of education. It’s about how you absorb information from healthcare professionals and understand why you should do different things. It could also be that a higher level of education is linked to a larger social network and better support from family and relatives,” says Rasmus Åhman.

The study was funded by Futurum – Academy forHealth and Care at Region Jönköping County, Linköping Medical Society and ALF funds from Region Östergötland.