Effects of socioeconomic status on functional status and health-related quality of life in hip fracture patients.

What is known? Hip fractures are debilitating osteoporotic fractures that are increasingly pervasive in our aging population. SES has an overarching influence on health outcomes and well-being, having already been proven in other morbid diseases. What is new? Overall, this study demonstrates that hip fracture patients experience poorer perioperative quality of life at different time points based on SES, though both groups recuperate to attain comparable outcomes by 1 year. What is the impact? Our findings suggest that hip fracture prevention should be emphasised across all socioeconomic strata. Health policies and coverage should be re-examined in the aging population, especially the need for mental health support during immediate recovery. INTRODUCTION: Hip fractures are increasingly prevalent in our fast-aging population, but effects of socioeconomic status (SES) on these patients' perioperative wellbeing are not well understood. This study aims to investigate the effect of SES, represented by hospital ward class, on perioperative function and health-related quality of life (HRQoL) in hip fracture patients. STUDY DESIGN AND METHODS: Four hundred forty-five hip fracture patients were prospectively followed up and categorised into private (PTE) and government-subsidised (SUB) ward classes as a surrogate for SES. Patients were evaluated using Parker Mobility Score (PMS), EuroQol-5 Dimensions (EQ-5D) and Short Form-36 (SF-36; including Physical Function PF and Mental Health MH) scores premorbidly, and postoperatively at 3 months, 6 months and 1 year. RESULTS: Group PTE scored significantly higher in PMS across all time points and in PF at 6 months (42.5 ± 27.3 vs 35.0 ± 29.1, p = 0.033) postoperatively. Group PTE also had superior EQ-5D scores at 3 (0.620 ± 0.282 vs 0.497 ± 0.325, p = 0.002) and 6 months (0.715 ± 0.268 vs 0.576 ± 0.334, p = 0.001) postoperatively. Group PTE had higher MH scores at 3 months (85.9 ± 15.0 vs 80.9 ± 18.1, p = 0.014) postoperatively, though its scores continued to decline by 6 months. Changes over time in EQ-5D scores favoured Group PTE (p = 0.016). Both groups had an overall decline at 3 months before gradually returning towards baseline at 1 year. CONCLUSION: This study highlights SES-based disparities in hip fracture patients perioperatively, though both groups converge to comparable outcomes by 1 year. Health policies should consider MH support during recovery for all, regardless of SES.