Abstract
In this nationwide cohort study, we investigated trends in hip fracture incidence, hospital length of stay (LOS), and 30-day mortality after admission in Sweden. The cohort included all individuals in Sweden aged ≥ 50 years with a first hip fracture diagnosis during 1998–2017 (N = 313,761). The outcomes were hip fracture incidence and 30-day mortality. The results showed that the incidence of hip fracture decreased from 79.2 to 46.7/10,000 population in women and from 35.7 to 26.5/10,000 population in men. In contrast, 30-day mortality increased from 4.3% to 6.2% in women (P < 0.001) and from 8.4% to 11.1% in men (P < 0.001). Strong risk factors (P < 1 × 10–25 for all) for 30-day mortality were older age, male sex, and shorter LOS. From 1998 to 2017, LOS decreased by on average 4 days and was shorter in both male and female aged ≥ 90 years compared to those aged 80–89 (P < 0.001 for comparisons). In conclusion, despite population aging, hip fracture incidence in Sweden has decreased over the last 20 years. However, short-term mortality has increased, which to some extent may partly be explained by the fact that LOS has decreased without being adapted to important risk factors.
Highlights
In 2000, an estimated nine million fragility fractures occurred worldwide [1], with adverse consequences including chronic pain [2], disability, and premature death [3, 4]
This nationwide study showed that both the incidence and the total number of hip fractures decreased in Sweden between 1998 and 2017, despite a concurrent aging of the population
Strong risk factors for higher mortality included older age, male sex, and length of stay (LOS) which decreased with 4 days during the study period
Summary
In 2000, an estimated nine million fragility fractures occurred worldwide [1], with adverse consequences including chronic pain [2], disability, and premature death [3, 4]. The hip fracture is the most devastating type of fracture both for the individual and the society [5], with nationwide studies and meta-analyses showing that about 25% of hip fracture patients die within a year of the event [4, 6, 7] Among those that survive, recovery to pre-fracture functional level is often unsuccessful [8]. We showed that in hip fracture patients, shorter LOS was associated with increased risk of death after discharge [6]. These results were confirmed in a recent study investigating hip fracture patients with dementia [22]. It could be hypothesized that efforts to reduce LOS related to economic constraints may have
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