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Background <p>Hip fractures represent a major public health burden in aging populations, with well-documented gender differences; however, ethnic disparities in hip fracture risk and outcomes, particularly between Arab and Jewish populations within universal healthcare system, remain understudied.</p> Objective <p>To determine ethnic and gender differences in the incidence of hip fractures and related outcomes among older adults in Israel.</p> Method <p>We conducted a retrospective cohort study using electronic medical records from Clalit Health Services between 2010 and 2019. Adults aged ≥ 50 years without prior hip fracture were included. Hip fracture incidence was assessed using validated diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for age, sex, socioeconomic status, smoking, and comorbidities.</p> Results <p>The cohort included 941,534 individuals (84.7% Jewish; 53.4% women). The overall incidence rate of hip fracture was 2.6 per 1,000 person-years. While crude incidence rates were comparable between groups, adjusted analyses showed that Arab individuals had a significantly higher risk of hip fracture compared with Jewish individuals (HR 1.45; 95% CI 1.38–1.52). In contrast, Arabs had a lower risk of non-hip fractures (HR 0.83; 95% CI 0.70–0.97). Elevated hip fracture risk was observed among both Arab men and Arab women relative to their Jewish counterparts.</p> Conclusion <p>Within a universal healthcare system, substantial ethnic disparities in hip fracture risk persist after adjustment for demographic and clinical factors. These findings suggest that differences in underlying risk profiles, healthcare utilization, or preventive care may contribute to inequities and warrant targeted, population-specific interventions.</p>

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Ethnic and gender differences in hip fracture risk among older adults: implications for prevention in a universal healthcare system

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Hiba Masri Iraqi,
  • Gloria Tsvetov,
  • Einav Dandeker,
  • Adi Turjeman,
  • Samah Hayek

摘要

Background

Hip fractures represent a major public health burden in aging populations, with well-documented gender differences; however, ethnic disparities in hip fracture risk and outcomes, particularly between Arab and Jewish populations within universal healthcare system, remain understudied.

Objective

To determine ethnic and gender differences in the incidence of hip fractures and related outcomes among older adults in Israel.

Method

We conducted a retrospective cohort study using electronic medical records from Clalit Health Services between 2010 and 2019. Adults aged ≥ 50 years without prior hip fracture were included. Hip fracture incidence was assessed using validated diagnostic codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for age, sex, socioeconomic status, smoking, and comorbidities.

Results

The cohort included 941,534 individuals (84.7% Jewish; 53.4% women). The overall incidence rate of hip fracture was 2.6 per 1,000 person-years. While crude incidence rates were comparable between groups, adjusted analyses showed that Arab individuals had a significantly higher risk of hip fracture compared with Jewish individuals (HR 1.45; 95% CI 1.38–1.52). In contrast, Arabs had a lower risk of non-hip fractures (HR 0.83; 95% CI 0.70–0.97). Elevated hip fracture risk was observed among both Arab men and Arab women relative to their Jewish counterparts.

Conclusion

Within a universal healthcare system, substantial ethnic disparities in hip fracture risk persist after adjustment for demographic and clinical factors. These findings suggest that differences in underlying risk profiles, healthcare utilization, or preventive care may contribute to inequities and warrant targeted, population-specific interventions.