Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study

Abstract

Mortality rates after hip fracture have not declined in 20 years. We assessed the impact of chronic obstructive pulmonary disease (COPD) on mortality after hip fracture, and compared mortality in this cohort to persons without hip fracture in a population-based prospective cohort study. Using Danish health care registries, we identified persons >or=40 years old with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003. Hospitalization for COPD was assessed from hospital discharge registries. Using Cox regression, we computed relative risks (RR) and 95% confidence intervals (CI) for mortality endpoints among persons with COPD compared to persons without COPD. Mortality following hip fracture was also compared to age and gender matched controls without hip fracture. We identified 11, 985 persons with first-time hospitalization for hip fracture; 771 (6.4%) had a diagnosis of COPD. Average follow up was 22 months. Compared to persons without COPD, mortality following hip fracture in persons with COPD was RR=1.58 (95% CI 1.30-1.90) at 30 days, RR=1.52 (95% CI 1.30-1.77) at 90-days, RR=1.58 (95% CI 1.40-1.78) at 1 year, and RR=1.71 (95% CI 1.55-1.88) overall. The 1-year mortality in persons with hip fracture and COPD was approximately 3-5 times greater than in controls without hip fracture. In this cohort, persons with COPD have a 60-70% higher risk of death following hip fracture than those without COPD. In addition, hip fracture and COPD increased 1-year mortality 3-5 times that of persons without hip fracture.