Clinical Research

Clinical Orthopaedics and Related Research®

, Volume 470, Issue 6, pp 1763-1770

First online:

Mortality Rates are Similar after Hip Fractures for Rural and Urban Patients

  • Benjamin J. MillerAffiliated withDepartment of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine Email author 
  • , Xueya CaiAffiliated withDepartment of Internal Medicine, University of Iowa Carver College of Medicine
  • , Peter CramAffiliated withDepartment of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of MedicineCADRE and the Rural Health Resource Center at the Iowa City VA

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Proximal femoral fractures are common in the elderly. The best care depends on expeditious presentation, medical stabilization, and treatment of the condition.


We investigated the risk of increased mortality in residents of rural communities secondary to inaccessible facilities and treatment delays.

Patients and Methods

We used Medicare Provider Analysis and Review Part A data to identify 338,092 patients with hip fractures. Each patient was categorized as residing in urban, large rural, or small rural areas. We compared the distance traveled, mortality rates, time from admission to surgery, and length of stay for patients residing in each location.


Patients in rural areas traveled substantially farther to reach their treating facility than did urban patients: mean, 34.4 miles for small rural, 14.5 miles for large rural, and 9.3 miles for urban. The adjusted odds ratios for mortality were similar but slightly better for urban patients for in-hospital mortality (small rural odds ratio, 1.05; large rural odds ratio, 1.13). Rural patients had a favorable adjusted odds ratio for 1-year mortality when compared with urban patients (small rural odds ratio, 0.93; large rural odds ratio, 0.96). Rural patients experienced no greater delay in time to surgery or longer hospital length of stay.


Although patients living in rural areas traveled a greater distance than those living in urban centers, we found no increase in time to surgery, hospital length of stay, or mortality.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.