Ethnicity differences in those attending and not attending a single centre UK fracture liaison service.

Mitchell, Sabrina; Hawarden, Ashley; Bullock, Laurna; Paskins, Zoe

Abstract

Background
Fracture liaison services (FLS) are concerned with the systematic identification of people that have sustained low trauma fractures to provide: an assessment of bone health; assessment of fracture (including bone density scan) and falls risk; treatment recommendations and follow-up to promote adherence to osteoporosis medicines.

UK population level data suggests that fracture rates are almost four times higher in white people compared to black people, and twice as high in white people compared to people of South Asian or mixed heritage [1]. However, evidence from north America suggests people of black heritage who have hip fractures are less likely to receive assessment for osteoporosis, with mixed evidence suggesting there may be under-assessment in people of other ethnicities [2].

The aim of this service evaluation was to: (a) formally describe the recorded ethnicity of people identified by our FLS; (b) compare recorded ethnicity of those who attend FLS with those who do not attend; (c) compare recorded ethnicity of those invited to FLS with population ethnicity.

Methods
The service evaluation was registered with the Midlands Partnership University NHS Foundation Trust (MPFT). Electronic health records (EHRs) were used to identify people who were invited for an FLS appointment between April 2023 and April 2024. We recorded attendance, sex at birth, age and recorded ethnic group.

The Office for National Statistics (ONS) census 2021 data details self-reported ethnicity by age group and local authority [3]. We extracted ethnicity data for people aged 50 years and older within MPFT’s FLS catchment area to represent the eligible population. A descriptive comparison was made between the ethnicity of people invited to MPFT FLS and the ethnic profile of the wider eligible population.

Results
1460 patients were invited to attend FLS of which, 1228 (84%) attended and 232 (16%) did not attend. 959 (78.1%) attenders and 164 (71%) non-attenders were female at birth. Age ranged from 50–90 years in attenders and 50–84 years in non-attenders. Ethnic group was recorded in 1346 (92.2%) of patient EHRs. The recorded ethnic groups of attenders and non-attenders to MPFT FLS, and the eligible population are summarised in Table 1.

Discussion
Ethnicity was recorded in over 92% patients, which is markedly higher than previously recorded in primary care (66%) [1]. A very high proportion of FLS invitees and attendees in were recorded as of white heritage (99%) which may reflect differences in fracture rates in people of different ethnicities. The proportion of people not attending recorded as of mixed or multiple ethnicity was higher than those attending (0.9% vs 0.3%) but numbers are too small to draw robust conclusions.

Conclusion
Although more work is needed to further improve the recording of ethnicity in the medical record, these results suggest that examining ethnicity of FLS invitees and attendees in UK hospital records is feasible. The question remains of whether there is inequality in secondary fracture prevention in people of Black, Asian or multiple heritage and further study is needed in larger populations, such as the UK national audit.

Citation

Mitchell, S., Hawarden, A., Bullock, L., & Paskins, Z. (in press). Ethnicity differences in those attending and not attending a single centre UK fracture liaison service. Archives of Osteoporosis, 19(1), Article 68. https://doi.org/10.1007/s11657-024-01431-1

• Journal Article Type: Letter
• Acceptance Date: Jul 19, 2024
• Online Publication Date: Aug 2, 2024
• Deposit Date: Aug 19, 2024
• Journal: Archives of osteoporosis
• Print ISSN: 1862-3522
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 1
• Article Number: 68
• DOI: https://doi.org/10.1007/s11657-024-01431-1
• Keywords: Osteoporotic Fractures - ethnology - epidemiology, Ethnicity - statistics & numerical data, Aged, United Kingdom, Fractures, Bone - ethnology - epidemiology, Humans, Male, Middle Aged, Aged, 80 and over, Female
• Public URL: https://keele-repository.worktribe.com/output/885210