Osteoporosis International

, Volume 17, Issue 10, pp 1569–1576 | Cite as

Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil

  • E. I. O. Vidal
  • C. M. Coeli
  • R. S. Pinheiro
  • K. R. CamargoJr
Original Article



The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil.


We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time—1–30 days, 31–90 days, and 91–365 days after hospital admission—and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge.


We found an overall 21.5% (95% CI 18.2–24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794–1450) and 512.8 (95% CI 366.4–698.3) for the first two periods, 1–30 days and 31–90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99–183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.


Hip fracture Mortality Older age epidemiology Osteoporosis Probabilistic record linkage 


  1. 1.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767PubMedCrossRefGoogle Scholar
  2. 2.
    Johnell O, Kanis JA (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7PubMedCrossRefGoogle Scholar
  3. 3.
    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413PubMedCrossRefGoogle Scholar
  4. 4.
    Melton LJ 3rd (1996) Epidemiology of hip fractures: implications of the exponential increase with age. Bone 18:121S–125SPubMedCrossRefGoogle Scholar
  5. 5.
    Johnell O, Kanis J (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902PubMedCrossRefGoogle Scholar
  6. 6.
    Zethraeus N, Stromberg L, Jonsson B, Svensson O, Ohlen G (1997) The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 68:13–17PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S; discussion 17S–19SPubMedCrossRefGoogle Scholar
  8. 8.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRefGoogle Scholar
  9. 9.
    Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, Rizzoli R (2002) Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int 13:731–737PubMedCrossRefGoogle Scholar
  10. 10.
    Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11:460–466PubMedCrossRefGoogle Scholar
  11. 11.
    Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M (1996) Epidemiology of hip fractures. Bone 18:57S–63SPubMedCrossRefGoogle Scholar
  12. 12.
    Nurmi I, Narinen A, Luthje P, Tanninen S (2003) Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 123:551–554PubMedCrossRefGoogle Scholar
  13. 13.
    Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103:20S–25S; discussion 25S–26SPubMedCrossRefGoogle Scholar
  14. 14.
    De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10:66–72PubMedCrossRefGoogle Scholar
  15. 15.
    Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228PubMedCrossRefGoogle Scholar
  16. 16.
    Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525PubMedCrossRefGoogle Scholar
  17. 17.
    Lichtblau S (2000) Hip fracture. Surgical decisions that affect medical management. Geriatrics 55:50–56PubMedGoogle Scholar
  18. 18.
    Jain R, Basinski A, Kreder HJ (2003) Nonoperative treatment of hip fractures. Int Orthop 27:11–17PubMedGoogle Scholar
  19. 19.
    Lu-Yao GL, Baron JA, Barrett JA, Fisher ES (1994) Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health 84:1287–1291PubMedGoogle Scholar
  20. 20.
    Lyons AR (1997) Clinical outcomes and treatment of hip fractures. Am J Med 103:51S–63S; discussion 63S–64SPubMedCrossRefGoogle Scholar
  21. 21.
    Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636PubMedGoogle Scholar
  22. 22.
    Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78PubMedCrossRefGoogle Scholar
  23. 23.
    Walker N, Norton R, Van der Hoorn S, Rodgers A, MacMahon S, Clark T, Gray H (1999) Mortality after hip fracture: regional variations in New Zealand. N Z Med J 112:269–271PubMedGoogle Scholar
  24. 24.
    Yuan Z, Dawson N, Cooper GS, Einstadter D, Cebul R, Rimm AA (2001) Effects of alcohol-related disease on hip fracture and mortality: a retrospective cohort study of hospitalized Medicare beneficiaries. Am J Public Health 91:1089–1093PubMedGoogle Scholar
  25. 25.
    Goldacre MJ, Roberts SE, Yeates D (2002) Mortality after admission to hospital with fractured neck of femur: database study. BMJ 325:868–869PubMedCrossRefGoogle Scholar
  26. 26.
    Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA (2005) Survival after hip fracture. Osteoporos Int 16:1583–1590PubMedCrossRefGoogle Scholar
  27. 27.
    Franzo A, Francescutti C, Simon G (2005) Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 20:985–991PubMedCrossRefGoogle Scholar
  28. 28.
    Karagiannis A, Papakitsou E, Dretakis K, Galanos A, Megas P, Lambiris E, Lyritis GP (2006) Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture. Calcif Tissue Int 78:72–77PubMedCrossRefGoogle Scholar
  29. 29.
    Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J (2003) Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 18:2231–2237PubMedCrossRefGoogle Scholar
  30. 30.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42PubMedCrossRefGoogle Scholar
  31. 31.
    Siqueira FV, Facchini LA, Hallal PC (2005) The burden of fractures in Brazil: a population-based study. Bone 37:261–266PubMedCrossRefGoogle Scholar
  32. 32.
    Goldacre MJ, Griffith M, Gill L, Mackintosh A (2002) In-hospital deaths as fraction of all deaths within 30 days of hospital admission for surgery: analysis of routine statistics. BMJ 324:1069–1070PubMedCrossRefGoogle Scholar
  33. 33.
    Jaro M (1989) Advances in record-linkage methodology as applied to matching the 1985 Census of Tampa, Florida. J Am Stat Assoc 84:414–420CrossRefGoogle Scholar
  34. 34.
    Jaro M (1995) Probabilistic linkage of large public health data files. Stat Med 14:491–498PubMedCrossRefGoogle Scholar
  35. 35.
    Camargo Jr KR, Coeli CM (2000) [Reclink: an application for database linkage implementing the probabilistic record linkage method]. Cad Saude Publica 16:439–447PubMedGoogle Scholar
  36. 36.
    Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jonsson PV, Poor G, Sisson de Castro JA, Xu L, Matkin CC, Nelson LM, Heyse SP (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int 9:242–253PubMedCrossRefGoogle Scholar
  37. 37.
    Komatsu RS, Simões MFJ, Ramos LR, Szejnfeld VL (1999) Incidência de fraturas de fêmur proximal em Marília, São Paulo, Brasil, 1994 e 1995. Rev Bras Reumat 39:325–331Google Scholar
  38. 38.
    Silveira VA, Medeiros MM, Coelho-Filho JM, Mota RS, Noleto JC, Costa FS, Pontes FJ, Sobral JB, Aguiar RF, Leal AC, Clemente CM (2005) Hip fracture incidence in an urban area in Northeast Brazil. Cad Saude Publica 21:907–912PubMedGoogle Scholar
  39. 39.
    Castro da Rocha FA, Ribeiro AR (2003) Low incidence of hip fractures in an equatorial area. Osteoporos Int 14:496–499PubMedCrossRefGoogle Scholar
  40. 40.
    Roberts SE, Goldacre MJ (2003) Time trends and demography of mortality after fractured neck of femur in an English population, 1968–98: database study. BMJ 327:771–775PubMedCrossRefGoogle Scholar
  41. 41.
    Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561PubMedCrossRefGoogle Scholar
  42. 42.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473PubMedCrossRefGoogle Scholar
  43. 43.
    Krieger N, Davey Smith G (2004) “Bodies count,” and body counts: social epidemiology and embodying inequality. Epidemiol Rev 26:92–103PubMedCrossRefGoogle Scholar
  44. 44.
    Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT (2002) Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am J Public Health 92:858–862PubMedCrossRefGoogle Scholar
  45. 45.
    Meyer HE, Tverdal A, Falch JA, Pedersen JI (2000) Factors associated with mortality after hip fracture. Osteoporos Int 11:228–232PubMedCrossRefGoogle Scholar
  46. 46.
    Katelaris AG, Cumming RG (1996) Health status before and mortality after hip fracture. Am J Public Health 86:557–560PubMedGoogle Scholar
  47. 47.
    Tjeenk R, Shepers A, van de Linde P, Breslau P, Peeters M (2002) Mortality registration in patients with a proximal femoral fracture admitted to a surgical ward. Eur J Trauma 28:95–99CrossRefGoogle Scholar
  48. 48.
    Poole KE, Reeve J, Warburton EA (2002) Falls, fractures, and osteoporosis after stroke: time to think about protection? Stroke 33:1432–1436PubMedCrossRefGoogle Scholar
  49. 49.
    Handoll HH, Sherrington C, Parker MJ (2005) Mobilisation strategies after hip fracture surgery in adults. The Cochrane Library, issue 2. Update Software, OxfordGoogle Scholar
  50. 50.
    Seiler W (2000) Consequences of immobility. In: Evans JG (ed) Oxford textbook of geriatric medicine. Oxford University Press, Oxford, pp 1175–1181Google Scholar
  51. 51.
    Kane R, Ouslander, J, Abrass I (2003) Immobility. In: Kane R, Ouslander J, Abrass I (eds) Essentials of clinical geriatrics. McGraw-Hill, New York, pp 245–277Google Scholar
  52. 52.
    Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 338:355–358PubMedCrossRefGoogle Scholar
  53. 53.
    Johansson C, Black D, Johnell O, Oden A, Mellstrom D (1998) Bone mineral density is a predictor of survival. Calcif Tissue Int 63:190–196PubMedCrossRefGoogle Scholar
  54. 54.
    Hamerman D (2005) Osteoporosis and atherosclerosis: biological linkages and the emergence of dual-purpose therapies. QJM 98:467–484PubMedCrossRefGoogle Scholar
  55. 55.
    Nawroth P, Pirzer R, Fohr B, Schilling T, Ziegler R, Bierhaus A, Kasperk C (2003) [Osteoporosis and cardiovascular disease-two sides of the same coin?]. Med Klin (Munich) 98:437–446CrossRefGoogle Scholar
  56. 56.
    Strausbaugh L (2001) Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 7:268–271PubMedCrossRefGoogle Scholar
  57. 57.
    Falsey AR (2000) Epidemiology of infectious diseases. In: Evans JG (ed) Oxford textbook of geriatric medicine. Oxford University Press, Oxford, pp 55–64Google Scholar
  58. 58.
    Colón-Emeric C, Sloane R, Hawkes W, Magaziner J, Zimmerman S, Pieper C, Lyles K (2000) The risk of subsequent fracture in community-dwelling men and male veterans with hip fracture. Am J Med 109:324–326PubMedCrossRefGoogle Scholar
  59. 59.
    [No authors listed] (1995) Computerised record linkage: compared with traditional patient follow-up methods in clinical trials and illustrated in a prospective epidemiological study. The West of Scotland Coronary Prevention Study Group. J Clin Epidemiol 48:1441–1452Google Scholar
  60. 60.
    Shannon HS, Jamieson E, Walsh C, Julian JA, Fair ME, Buffet A (1989) Comparison of individual follow-up and computerized record linkage using the Canadian Mortality Data Base. Can J Public Health 80:54–57PubMedGoogle Scholar
  61. 61.
    Partanen J, Syrjala H, Vahanikkila H, Jalovaara P (2006) Impact of deep infection after hip fracture surgery on function and mortality. J Hosp Infect 62:44–49PubMedCrossRefGoogle Scholar
  62. 62.
    Levcovitz E, Pereira T (1993) Uma Ánalise do Sistema Público de Remuneração de Internações Hospitalares. Série Est Saúde Col UERJ 57:1–83Google Scholar
  63. 63.
    Castro MSM, Travassos C, Carvalho MS (2002) [Analysis of hospital admissions associated factors in Brazil]. Ciênc Saúde Coletiva 7:795–811CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • E. I. O. Vidal
    • 1
  • C. M. Coeli
    • 2
    • 3
  • R. S. Pinheiro
    • 3
  • K. R. CamargoJr
    • 4
  1. 1.Department of Preventive and Social MedicineState University of CampinasAmericanaBrazil
  2. 2.Department of Epidemiology, Institute of Social MedicineState University of Rio de JaneiroRio de JaneiroBrazil
  3. 3.Nucleus for Studies in Collective Health (NESC)Federal University of Rio de JaneiroRio de JaneiroBrazil
  4. 4.Institute of Social Medicine,Department of Health Planning and AdministrationState University of Rio de JaneiroRio de JaneiroBrazil

Personalised recommendations