The effect of health inequalities on outcomes of trauma and orthopaedic surgery following falls in the elderly

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Section 1 - Basic information about you and your application:

Title of research project
The effect of health inequalities on outcomes of trauma and orthopaedic surgery following falls in the elderly

Project summary
Whether health inequalities have an impact on outcomes following surgery for falls is yet to be established. This multi-centre prospective cohort study will aim to compare outcomes of surgery following falls between patients with and without health inequalities. This project will aid my pursuit of a career in academic trauma and orthopaedic surgery.
Type of project

Type of research

Trauma & Orthopaedic surgery

Start date

End date

Section 2 - Purpose of the research and originality

Aims / Objectives:

To compare outcomes following falls requiring hospital admission between patients with and without health inequalities before and after the COVID-19 pandemic, including:

  • Malnutrition (albumin < 3.5 mg/dL)
  • Employment status (employed vs unemployed)
  • Post code (using publicly-accessible data to establish a proxy for socioeconomic status)
  • Literacy (using maximum educational attainment as a proxy)
  • Ethnicity
  • Sex
  • Comorbidities
Background to investigation

11.1 million adults aged 65 years and over currently live in the UK. This is projected to reach 14.9 million by 2030 [1]. Accidental falls are a major cause of morbidity and mortality within this population. These result from the interactions between a patient’s environment and physical condition [2]. Falls cost the National Health Service £2.3 billion per year [2]. In addition, 5% of falls lead to fractures, and a third of people who experience them die within one year [1].

There is a well-established link between health inequalities and increased morbidity and mortality [3-5]. For instance, hospitals treating patients with lower socioeconomic status have worse outcomes when compared to other hospitals [6]. Socioeconomic status has also been implicated in reduced use of health services [7]. However, whether these have an impact on outcomes following surgery for falls is yet to be established. Exploring the effect of health inequalities (due to muscle deconditioning or malnutrition) on morbidity and mortality following surgery for falls could allow for the identification of at-risk groups and the creation of public policy targeting these, reducing morbidity, mortality and social costs.


  1. Office for Health Improvement and Disparities. Falls: applying all our health. Gov.UK. 2022 [cited 06 October 2023]. Available from: https://www.gov.uk/government/publications/fallsapplying-all-our-health/falls-applying-all-our-health
  2. World Health Organisation. WHO Global Report on Falls Prevention in Older Age. 2008 [cited 06 October 2023]. Available from: https://www.who.int/publications/i/item/9789241563536.
  3. Bambra C, Eikemo TA. Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self‐reported health in 23 European countries. J. Epidemiol. Community Health 2009; 63: 92–8.
  4. Marmot M, Wilkinson RG (eds). Social Determinants of Health. Oxford University Press, 2005. [cited 10 October 2023.] Available from URL:; 2nd ed. https://books.google.com/books/about/Social_Determinants_of_Health.html?id=AmwiS8HZeRIC.
  5. Bartley M. Unemployment and ill health: understanding the relationship. J. Epidemiol. Community Health 1994; 48: 333–7. 
  6. Birkmeyer NJO, Gu N, Baser O, Morris AM, Birkmeyer JD. Socioeconomic status and surgical mortality in the elderly. Med. Care 2008; 46: 893–9.
  7. Kapur S, Sakyi KS, Lohia P, Goble DJ. Potential Factors Associated with Healthcare Utilization for Balance Problems in Community-Dwelling Adults within the United States: A Narrative Review. Healthcare (Basel). 2023 Aug 26;11(17):2398.

Purpose of the research and originality(Required)

Other documents

Applicant CV: Download here
Reference letter: Download here