Abstract
ABSTRACTHigher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Highlights
Hip fractures represent a major health problem in Western societies, and numbers are likely to increase with an aging population.[1]. Hip fractures are associated with considerably impaired function and reduced quality of life in the individual patient, and constitute a major economic burden on the health-care systems.[2,3,4,5] There is a considerably increased posthip fracture mortality,(6) which is associated with numerous risk factors, both in terms of individual patient characteristics such as comorbidity, age, and sex, as well as health-care system-related factors, such as waiting time to surgery.[7,8] Urbanization is interesting when addressing posthip fracture mortality, as transportation time to hospital and the quality of health-care services may differ between urban and rural areas, and this could possibly affect mortality
The results from previous studies are somewhat disparate,(10–12) and we identified only one small study on urban–rural differences in long-term (5 years) mortality.[11] if mortality in the general population differs by category of urbanization, this could potentially explain any observed urban–rural differences in hip fracture mortality
The aims of the current study were to examine: [1] any urban–rural differences in short-term and long-term absolute mortality; [2] any urban–rural differences in short-term and long-term relative mortality; [3] whether possible urban–rural differences could be explained by sociodemographic factors such as level of education, number of children, and whether the patient lived alone or not; and [4] urban–rural differences in excess mortality in hip fracture patients compared with the general population
Summary
Hip fractures represent a major health problem in Western societies, and numbers are likely to increase with an aging population.[1]. The results from previous studies are somewhat disparate,(10–12) and we identified only one small study on urban–rural differences in long-term (5 years) mortality.[11] if mortality in the general population differs by category of urbanization, this could potentially explain any observed urban–rural differences in hip fracture mortality. The aims of the current study were to examine: [1] any urban–rural differences in short-term and long-term absolute mortality; [2] any urban–rural differences in short-term and long-term relative mortality; [3] whether possible urban–rural differences could be explained by sociodemographic factors such as level of education, number of children, and whether the patient lived alone or not; and [4] urban–rural differences in excess mortality in hip fracture patients compared with the general population
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