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

Background: 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. Methods: 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. Results: 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). Discussion: 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 6th decile or higher. This suggests that the available incapacity programs are limited in providing income protection to patients with higher incomes.