Abstract
BackgroundEstimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia.MethodsRetrospective, population-based 10-year study of persons aged ≥50 in two cohorts: with hip fracture and an age- and sex-matched (in a 1:4 ratio) random sample from the national health insurance fund database for comparison. Cumulative risks, excess risks and relative risks of death were estimated using Poisson regression with 95% bootstrap confidence intervals (CI). Risks were adjusted for age and Charlson comorbidity index.ResultsWe identified 8298 (2383 men, 5915 women) incident hip fracture patients from 2005 to 2013 and 33,191 (9531 men, 23,660 women) individuals for the reference group. 5552 (1564 men, 3988 women) cases and 14,037 (3514 men, 10,523 women) reference individuals died during the 10-year follow-up period. Among hip fracture patients we observed a pronounced and durable excess risk of death that was highest within 3–6 months after fracture and persisted for the full 10-year follow-up period. After adjustment for age and Charlson index, hip fracture was associated with a 21.1% (95% CI 20.0–22.5%) 10-year cumulative excess risk of death (RR 1.37, 95% CI 1.35–1.40). We found a high immediate excess risk of death in older age groups (≥80 years) and gradually accumulating excess risk in younger age groups (50–79 years). The excess risk was more pronounced among men than women.ConclusionsBy the end of the 10-year follow-up, 1 in 4 deaths in the hip fracture group was attributable to the hip fracture. The results indicate a high attributable impact of hip fracture as an independent risk factor for death.
Highlights
Estimates of hip fracture mortality in Eastern Europe are scarce
Characteristics of hip fracture patients and reference group subjects From the Estonian Health Insurance Fund (EHIF) database we identified 8298 (2383 men, 5915 women) incident hip fracture patients and 33,191 (9531 men, 23,660 women) individuals for the reference group between 2005 and 2013 (Table 1)
Men were 8.2 years younger than women at hip fracture, over 70% of men were younger than 80 years at hip fracture while 60% of women were 80 years or older
Summary
Estimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia. A recent report of osteoporosis in the European Union estimated that mortality related to low-impact trauma hip fracture is greater than road traffic accidents and equivalent to breast cancer [3]. This mortality burden will increase over the few decades commensurate with the aging of the population [3]. Targeted interventions among at-risk groups may contribute to mortality reductions [1], a contemporary epidemiology of hip fracture mortality would be useful in developing risk profiles and estimates of. The data describing excess mortality after hip fracture are well established in developed Western European and North American countries [1, 5]. The relative risk decreases in subsequent years, it does not return to that of age- and sex-matched reference groups
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