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Mortality following fragility hip fracture in China: a record linkage study

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Abstract

Summary

Mortality risk declined over time. Patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China.

Purpose

Hip fractures in older adults often lead to an elevated risk of death. However, few studies investigated mortality risk following hip fracture in mainland China. This retrospective cohort study aimed to evaluate the crude mortality and excess mortality after fragility hip fractures in Lishui residents aged 50 years and older.

Methods

Patients having a fragility hip fracture between October 2013 and August 2019 were identified from the Lishui District Inpatient Data Collection and followed up until August 2020. Death information was ascertained from the linked death registry records. We calculated the follow-up mortality rate and corresponding 95% confidence intervals (CIs) as well as the standard mortality ratios (SMRs) in comparison with the mortality rates of Lishui residents.

Results

During the study period, a total of 808 patients (63.4% females) with an average age of 75 years were admitted for fragility hip fractures. The 1st, 2nd, and 3rd year follow-up mortality rates were 16.51, 6.06, and 5.03 per 100 person-year, respectively. The SMRs were 8.46 (6.94, 9.97), 5.74 (4.86, 6.63), and 4.63 (3.98, 5.27) for the 1st, 2nd, and 3rd year following fragility hip fracture.

Conclusion

Although mortality risk declined over time, patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to restrictions to the availability of these data.

References

  1. World Health Organization (2022) International day of older persons - 1 October 2022. Available at: https://www.who.int/srilanka/news/detail/01-10-2022-international-day-of-older-persons---1-october-2022. Accessed 26 October 2022.

  2. Rupp M, Walter N, Pfeifer C et al (2021) The incidence of fractures among the adult population of Germany–an analysis from 2009 through 2019. Dtsch Arztebl Int 118:665–669

    PubMed  PubMed Central  Google Scholar 

  3. Clynes MA, Harvey NC, Curtis EM, Fuggle NR, Dennison EM, Cooper C (2020) The epidemiology of osteoporosis. Br Med Bull 133:105–117

    PubMed  Google Scholar 

  4. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  PubMed  Google Scholar 

  5. Tajeu GS, Delzell E, Smith W et al (2014) Death, debility, and destitution following hip fracture. J Gerontol A Biol Sci Med Sci 69:346–353

    Article  PubMed  Google Scholar 

  6. Yoon HK, Park C, Jang S et al (2011) Incidence and mortality following hip fracture in Korea. J Korean Med Sci 26:1087–1092

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wang CB, Lin CF, Liang WM et al (2013) Excess mortality after hip fracture among the elderly in Taiwan: a nationwide population-based cohort study. Bone 56:147–153

    Article  PubMed  Google Scholar 

  8. Koh GH, Tai BC, Ang LW et al (2013) All-cause and cause-specific mortality after hip fracture among Chinese women and men. Osteoporos Int 24:1981–1989

    Article  PubMed  Google Scholar 

  9. National Bureau of Statistics (2021) The seventh national population census. Available at: http://www.stats.gov.cn/tjsj/zxfb/202105/t20210510_1817176.html. Accessed 2 July 2021.

  10. Zeng Q, Li N, Wang Q et al (2019) The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey. J Bone Miner Res 34:1789–1797

    Article  PubMed  Google Scholar 

  11. Zhang C, Feng J, Wang S et al (2020) Incidence of and trends in hip fracture among adults in urban China: a nationwide retrospective cohort study. PLoS Med 17:e1003180

    Article  PubMed  PubMed Central  Google Scholar 

  12. Baidu Wikipedia (2022) Lishui District. Baidu Wikipedia website. Available at: https://baike.baidu.com. Accessed 26 October 2022.

  13. Chen Y, Jiao Z, Chen P, Fan L, Zhou X, Pu Y et al (2021) Short-term effect of fine particulate matter and ozone on non-accidental mortality and respiratory mortality in Lishui district. China BMC Public Health 21:1661

    Article  PubMed  Google Scholar 

  14. Toson B, Harvey LA, Close JC (2015) The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture. J Clin Epidemiol 68:44–51

    Article  PubMed  Google Scholar 

  15. Rossen LM, Ahmad FB, Anderson RN et al (2021) Disparities in excess mortality associated with COVID-19 - United States, 2020. MMWR Morb Mortal Wkly Rep 70:1114–1119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bischoff HA, Stähelin HB, Dick W et al (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351

    Article  CAS  PubMed  Google Scholar 

  17. Kim KM, Choi HS, Choi MJ, Chung HY (2015) Calcium and vitamin D supplementations: 2015 position statement of the Korean Society for Bone and Mineral Research. J Bone Metab 22:143–149

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K (2008) Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res 23:741–749

    Article  CAS  PubMed  Google Scholar 

  19. Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y, Afanador-Restrepo DF, Carcelén-Fraile MDC, López-Ruiz E (2022) Current status of the diagnosis and management of osteoporosis. Int J Mol Sci 23:9465

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ip TP, Leung J, Kung AW (2010) Management of osteoporosis in patients hospitalized for hip fractures. Osteoporos Int 21:S605–S614

    Article  CAS  PubMed  Google Scholar 

  21. Wang PW, Yao XD, Zhuang HF et al (2022) Mortality and related risk factors of fragile hip fracture. Orthop Surg 14:2462–2469

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chakhtoura M, Dagher H, Sharara S et al (2021) Systematic review of major osteoporotic fracture to hip fracture incidence rate ratios worldwide: implications for Fracture Risk Assessment Tool (FRAX)-derived estimates. J Bone Miner Res 36:1942–1956

    Article  PubMed  Google Scholar 

  23. Yong EL, Ganesan G, Kramer MS, Howe TS, Koh JSB, Thu WP et al (2020) Risk factors and trends associated with mortality among adults with hip fracture in Singapore. JAMA Netw Open 3:e1919706

    Article  PubMed  Google Scholar 

  24. Yoo JI, Kim HY, Jang S, Lee YK, Ha YC (2020) Risk factors for subsequent hip fractures and fatality after an initial hip fracture in Korea: using nationwide claims data. Arch Osteoporos 15:165

    Article  PubMed  Google Scholar 

  25. ESHRE Capri Workshop Group (2016) The influence of social factors on gender health. Hum Reprod 31:1631–1637

    Article  Google Scholar 

  26. Merzel C (2000) Gender differences in health care access indicators in an urban, low-income community. Am J Public Health 90:909–916

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Mustard CA, Kaufert P, Kozyrskyj A, Mayer T (1998) Sex differences in the use of health care services. N Engl J Med 338:1678–1683

    Article  CAS  PubMed  Google Scholar 

  28. McLaughlin D, Vagenas D, Pachana NA, Begum N, Dobson A (2010) Gender differences in social network size and satisfaction in adults in their 70s. J Health Psychol 15:671–679

    Article  PubMed  Google Scholar 

  29. Lau ES, Paniagua SM, Guseh JS et al (2019) Sex differences in circulating biomarkers of cardiovascular disease. J Am Coll Cardiol 74:1543–1553

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. School of Public Health of Southeast University, Health Committee in Lishui District, Statistics Bureau in Lishui District et al (2020) Lishui Whitebook. Nanjing, China.

  31. Tosteson AN, Gottlieb DJ, Radley DC et al (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18:1463–1472

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Li S, Sun T, Liu Z (2016) Excess mortality of 1 year in elderly hip fracture patients compared with the general population in Beijing. China Arch Osteoporos 11:35

    Article  PubMed  Google Scholar 

  33. Tsuboi M, Hasegawa Y, Suzuki S et al (2007) Mortality and mobility after hip fracture in Japan: a ten-year follow-up. J Bone Joint Surg Br 89:461–466

    Article  CAS  PubMed  Google Scholar 

  34. Wakasugi M, Kazama JJ, Wada A, Hamano T, Masakane I, Narita I (2020) Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan. J Bone Miner Metab 38:718–729

    Article  PubMed  Google Scholar 

  35. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP (2019) Frailty: implications for clinical practice and public health. Lancet 394:1365–1375

    Article  PubMed  Google Scholar 

  36. Wang O, Hu Y, Gong S et al (2015) A survey of outcomes and management of patients post fragility fractures in China. Osteoporos Int 26:2631–2640

    Article  CAS  PubMed  Google Scholar 

  37. Chen M, Du Y, Tang W, Yu W, Li H, Zheng S, Cheng Q (2022) Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China. J Bone Miner Metab 40:951–959

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank the project team from the Lishui Renmin Hospital, Lishui Health Commission of Lishui, in particular for study coordination and data collection, data processing, and data management. Hua Y contributed to the data analysis, results interpretation, and manuscript preparation and revision. Du W, Fan L, Zhou J, Moayyeri A, and Libanati C conceived the study and contributed to the results interpretation, critical review, and manuscript revision. All authors contributed to the critical review, results interpretation, and manuscript revision, and approved the final manuscript as submitted.

Funding

This study was supported by the Fundamental Research Funds for the Central Universities (No.3225002002A1), Department of Education (No.1125000172), the National Natural Science Foundation of China (Grant Number: 71704192, 82173899), and UCB Biopharma.

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Authors and Affiliations

  1. School of Public Health, Southeast University, Gulou District, 87 Dingjiaqiao, Nanjing, 210000, Jiangsu, China

    Yiwen Hua, Ying Li, Lijun Fan, Feng Huang, Hui Xue, Yong Tian & Wei Du

  2. UCB Pharma, Cambridge, MA, US

    Jiachen Zhou

  3. Department of Trauma Orthopedics, Lishui Renmin Hospital & Zhongda Hospital, Nanjing, China

    Zhanpo Wu, Bingquan Yang & Yunfeng Rui

  4. Lishui Smart City Operating Command Center, Nanjing, China

    Ping Chen

  5. UCB Pharma, Slough, UK

    Alireza Moayyeri

  6. UCB Pharma, Brussels, Belgium

    Cesar Libanati

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  1. Yiwen Hua
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  2. Ying Li
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  14. Wei Du
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Corresponding author

Correspondence to Wei Du.

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Conflicts of interest

Zhou J, Moayyeri A, and Libanati C are current employees of UCB Biopharma and may hold/have access to stock options. Hua Y, Li Y, Fan L, Huang F, Wu Z, Xue H, Yang B, Chen P, Rui Y, Tian Y, and Du W declare that they have no conflict of interest.

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Hua, Y., Li, Y., Zhou, J. et al. Mortality following fragility hip fracture in China: a record linkage study. Arch Osteoporos 18, 105 (2023). https://doi.org/10.1007/s11657-023-01304-z

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