Abstract
BackgroundHip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. The present prospective study investigated short- and long-term excess mortality after hip fractures with adjustment of other risk factors. We calculated the population attributable risk proportion (PARP) to assess the impact of each risk factor on excess mortality.MethodsWe recruited 217 elders with hip fractures and 215 age- and sex-matched patients without fractures from the geriatric department of the same hospital. The mean follow-up time was 46.1 months (range: 35 to 57 months). We recorded data on 55 covariates, including baseline details about health, function, and bone mineral density. We used the multivariate Cox proportional hazards model to analyze hazard ratios (HRs) of short-term (<12 months follow-up) and long-term (≧12 months follow-up) excess mortality for each covariate and calculated their PARP.ResultsPatients with hip fractures had a higher short-term mortality than non-fractured patients, and the long-term excess mortality associated with hip fracture remained high. The significant risk factors for short-term mortality were hip fracture, comorbidities, and lower (below cutoff) Mini Mental State Examination score with HRs of 2.4, 2.3, and 2.3, respectively. Their PARPs were 44.7%, 38.1%, and 34.3%, respectively. The significant risk factors for long-term mortality were hip fracture (HR: 2.7; PARP: 48.0%), lower T-score (HR: 3.3; PARP: 36.2%), lower body mass index (HR: 2.5; PARP: 42.8%), comorbidities (HR: 2.1; PARP: 34.8%), difficulty in activities of daily living (HR: 1.9; PARP: 31.8%), and smoking (HR: 2.5; PARP: 19.2%).ConclusionsAfter comprehensive adjustment, hip fracture was a significant risk factor and contributed the most to long-term as well as short-term excess mortality. Its adequate prevention and treatment should be targeted.
Highlights
Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial
The incidence of hip fractures has been decreasing in some regions, such as North America and Australia, it is still increasing in Asia, Latin America, the Middle East, and some parts of Europe [4,5]
In the hip fracture group, 12.4% of those patients died versus 3.7% in the non-fracture group (HR 3.5; 95% Confidence interval (CI) 1.6-7.6)
Summary
Hip fracture has a high mortality rate, but the actual level of long-term excess mortality and its impact on population-wide mortality remains controversial. Higher mortality immediately after hip fracture is well documented, and almost all studies have reported significant short-term excess mortality after this injury [7,8,9,10,11,12]. The risk of death decreases with time, but how long exactly the excess mortality persists after hip fracture has not been settled. Some suggest it does not last long [13,14,15,16], while others say it may persist for as long as 10 years [12,17,18]
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