The impact of geographic and socioeconomic variation on the incidence of hip fracture, and upon death and recovery after hip fracture
Researchers: Dr Arti Bhimjiyani, Prof Yoav Ben-Shlomo, Prof Celia L Gregson
External Collaborators: Dr Jenny Neuberger, Dr Antony Johansen
Funder: The National Osteoporosis Society (£79,457)
Outline: Each year 70,000 older adults break their hip in England and Wales; this will increase with our ageing population. A month after hip fracture between 3 and 17% have died and 25-95% have still not returned home. The number of hip fractures and their outcomes are variable across different parts of the country. We plan to determine how commonly hip fractures occur in different parts of the country. Unfortunately socially deprived individuals may be more likely to break a hip and less likely to recover from it. We will examine how varying levels of deprivation across our country influences how people recover from hip fractures; for example, how frequently they die, how long they stay in hospital, how likely they are to walk and return to their own home (versus move to a care home), and how frequently they have to go back into hospital. We will determine whether these inequalities are caused by differences in health before the fracture, or by housing circumstances, standards of hospital care or differences in recovery. This will help with the design of policies to reduce inequalities. Our findings are designed to drive equal access to high quality services for all hip fracture patients.
Project timeline: 2015-2019
Publications to date:
The effect of social deprivation on hip fracture incidence in England has not changed over 14 years: an analysis of the English Hospital Episodes Statistics (2001-2015). Osteoporos Int. 2018 Jan;29(1):115-124. Bhimjiyani A, Neuburger J, Jones T, Ben-Shlomo Y, Gregson CL.
Inequalities in hip fracture incidence are greatest in the North of England: regional analysis of the effects of social deprivation on hip fracture incidence across England Science Direct. 2018 Sep; Vol 162: 25-31. Bhimjiyani A, Neuburger J, Jones T, Ben-Shlomo Y, Gregson CL.
How does deprivation influence secondary care costs after hip fracture? Osteoporisis Int. 2020 Apr;31(8):1573-85. Glynn J, Hollingworth W, Bhimjiyani A, Ben-Shlomo Y, Gregson CL.
Bhimjiyani A (2019) Social and Regional Inequalities in the Incidence of and Outcomes after Hip Fracture in England. PhD Thesis. Dept Translational Health Sciences University of Bristol, Bristol Medical School Thesis Repository
Project Data:
To answer our research questions we are analysing a large national dataset from the Royal College of Physician’s Falls and Fragility Fracture Audit programme (RCP FFFAP) , specifically the National Hip Fracture Database (NHFD) alongside data from NHS Digital. NHS Digital links the data from NHFD to information it collects and extracts details of all hospital admissions (Hospital Episodes Statistics; HES) and data from the Office of National Statistics (ONS) for the study.
NHS Digital securely transfers the linked data to the University of Bristol as pseudonymised data (i.e. all patient identifiers are removed and replaced with a unique patient ID), so patients cannot be identified. The data are then held securely at the University of Bristol (the Data Controller). The ONS data provides us with information as to whether people have died at specific time points throughout the year following hip fracture.
NHS Research Ethics Committee approval: 15/LO/1056
NHS Digital Data Sharing Agreement: DARS-NIC-30645-Z2Z2K-v1.2
RCP FFFAP approval: FFFAP/2015/001
Further details regarding the NHFD data are available here, including the process to follow if you do not want your data to be included in this clinical audit and associated research activity.
Privacy notice
The University of Bristol is committed to using health care data in a safe and responsible manner. We use this information to study the NHS hip fracture service, how it functions and how it might be improved. This information is about the public and how they use NHS services, you therefore have a right to know what information we have and how we intend to use it. Below you will find information to help you understand the data we hold.
The data controller is the University of Bristol. For more information please contact Dr Rita Patel (Rita.Patel@bristol.ac.uk) who is the researcher responsible for management of these data.
The purpose
Each year 70,000 older adults break their hip in England and Wales; this will increase with our ageing population. A month after hip fracture between 3 and 17% have died and 25-95% have still not returned home. The number of hip fractures and their outcomes are variable across different parts of the country. We will determine how commonly hip fractures occur in different parts of the country. Unfortunately socially deprived individuals may be more likely to break a hip and less likely to recover from it. We will examine how varying levels of deprivation across our country influences how people recover from hip fractures; for example, how frequently they die, how long they stay in hospital, how likely they are to walk and return to their own home (versus move to a care home), and how frequently they have to go back into hospital. We will determine whether these inequalities are caused by differences in health before the fracture, or by housing circumstances, standards of hospital care or differences in recovery. This will help with the design of policies to reduce inequalities. Our findings are designed to drive equal access to high quality services for all hip fracture patients.
Project Data:
To answer our research questions we are analysing a large national dataset from the Royal College of Physician’s Falls and Fragility Fracture Audit programme (RCP FFFAP) , specifically the National Hip Fracture Database (NHFD) alongside data from NHS Digital. NHS Digital links the data from NHFD to information it collects and extracts details of all hospital admissions (Hospital Episodes Statistics; HES) and data from the Office of National Statistics (ONS) for the study.
NHS Digital securely transfers the linked data to the University of Bristol as pseudonymised data (i.e. all patient identifiers are removed and replaced with a unique patient ID), so patients cannot be identified. The data are then held securely at the University of Bristol (the Data Controller). The ONS data provides us with information as to whether people have died at specific time points throughout the year following hip fracture.
Legal basis for processing
For NHFD, HES and PEDW data are under Section 251 NHS Act 2006; Article 6(1) (e) - processing necessary for the performance of a task carried out in the public interest; and Article 9(2) (j)- processing necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and interests of the data subject.
Sharing
These data are stored in a safe and secure way and only accessed by specific members of the research team. The data are only be used to study the NHS and not used commercially. The data are not shared.
Retention
At the completion of the research the data will be archived and retained in line with the funding body policies. The current retention period is until: 01/03/2021
Your rights
Legislation gives you the right to see what information an organisation stores about you and request copies of it as well as other rights in respect of the processing of your personal data.
You can find out more about these rights, when they might apply and how to exercise them in your data protection rights here: http://www.bristol.ac.uk/secretary/data-protection/policy/research-participant-fair-processing-notice/.
Opt out
If you would like to opt out and not have your data used for this type of research, please contact:
Falls and Fragility Fracture Audit Programme, FFFAP (NHFD data): NHFD@rcplondon.ac.uk
NHS Digital (HES data): enquiries@nhsdigital.nhs.uk
NHS Wales Informatics Service (PEDW data): PHW.InformationGovernance@wales.nhs.uk
More information on opting out can be found on the NHFD website:
https://www.rcplondon.ac.uk/projects/outputs/fffap-data-processing-statements
NHS Digital website: https://digital.nhs.uk/services/national-data-opt-out-programme
NHS Wales Informatics Service website: https://nwis.nhs.wales/use-of-site/privacy-policy/"
In addition the University of Bristol provide fair processing information via websites at http://www.bristol.ac.uk/secretary/data-protection/policy/research-participant-fair-processing-notice/
Fair processing information is given to patients participating in NHFD by their enrolling hospitals and https://www.rcplondon.ac.uk/projects/outputs/fffap-data-processing-statements.
Data Protection Officer
The University is required to have a data protection officer who can be contacted if you have any queries, concerns or complaints about the way your personal data is processed. The University of Bristol’s Data Protection Officer (DPO) is Henry Stuart:
Henry Stuart
Information Governance Manager & Data Protection Officer
University Secretary's Office
University of Bristol
Beacon House
Queens Road
Bristol, BS8 1QU
Tel: 0117 39 41824
The Information Commissioner’s office is responsible for regulating data protection in the UK. We hope to resolve any of your questions, queries or concerns but if you remain dissatisfied you can contact the Information Commissioner's Office https://ico.org.uk/global/contact-us/