Abstract
Hip fracture is a major public health concern, with high incidence rates in the elderly worldwide. Hip fractures are associated with increased medical costs, patient dependency on families, and higher rates of morbidity and mortality. Chinese herbal medicine (CHM) is typically characterized as cost-effective and suitable for long-term use with few side effects. To better understand the effects of CHM on hip fracture patients, we utilized a population-based database to investigate the demographic characteristics, cumulative incidence of overall mortality, readmission, reoperation, and patterns of CHM prescription. We found that CHM usage was associated with a lower risk of overall mortality [P = 0.0009; adjusted hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.30–0.73], readmission (P = 0.0345; adjusted HR: 0.67, 95% CI: 0.46–0.97), and reoperation (P = 0.0009; adjusted HR: 0.57, 95% CI: 0.40–0.79) after adjustment for age, type of hip fracture, surgical treatment type, and comorbidities. We also identified the herbal formulas, single herbs, and prescription patterns for the treatment of hip fracture by using association rule mining and network analysis. For hip fracture patients, the most common CHM coprescription pattern was Du-Zhong (DZ) → Xu-Duan (XD), followed by Du-Huo-Ji-Sheng-Tang (DHJST) → Shu-Jing-Huo-Xue-Tang (SJHXT), and Gu-Sui-Bu (GSB) → Xu-Duan (XD). Furthermore, XD was the core prescription, and DZ, GSB, SJHXT, and DHJST were important prescriptions located in cluster 1 of the prescription patterns. This study provides evidence for clinical CHM use as an adjunctive therapy that offers benefits to hip fracture patients.
Highlights
Hip fracture is a major public health concern with a high incidence rate, especially in elder patients worldwide (Friedman and Mendelson, 2014; Lin and Liang, 2017)
Subjects were identified based on the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM). This population was part of a database comprising all individuals 40 years of age or older who received surgery for hip fracture based on a) first discharge disease codes of hip fracture: ICD9-CM: 820, 820.0, 820.00, 820.01, 820.02, 820.09, 820.8, 820.03, 820.2, 820.20, and 820.21; and b) procedure codes with surgery of internal fixation or hemiarthroplasty during the period from 2000 to 2010 who were included in the National Health Insurance Research database (NHIRD; http://nhird.nhri.org.tw/) of the National Health Insurance (NHI) program
Compared with the hip fracture patients who had intertrochanter fracture of the femur, patients who had an intracapsular fracture of the femoral neck had a higher risk of readmission
Summary
Hip fracture is a major public health concern with a high incidence rate, especially in elder patients worldwide (Friedman and Mendelson, 2014; Lin and Liang, 2017). CHM is believed to maintain bone health, including: inhibition of inflammation, promotion of fracture healing, osteopenia prevention, and antiosteoporotic activities (Chow et al, 1982; Chen et al, 2005; Li et al, 2011; Ma et al, 2011; Xiang et al, 2011; Wong et al, 2013; He and Shen, 2014; Zhang et al, 2016; Hsiao et al, 2017; Wang et al, 2018c; Xi et al, 2018; Lee et al, 2019) These studies have encouraged the search for complementary therapy for the better management of bonerelated diseases. Through this retrospective population-based case– control analysis, we were able to investigate whether the use of CHM as adjunctive therapy offers benefits to hip fracture patients
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