Hip fractures cluster in space: an epidemiological analysis in Portugal
Using Portuguese hospital registers (2000–2002) we calculated age-standardized incidence rates of hip fractures. Spatial clusters of high incidence rates were found, with annual averages (per 100,000 inhabitants) varying from 154.4 to 572.2 and 77.3 to 231.5 for women and men, respectively. Geographic inequalities in the occurrence of hip fractures were also found.
The aim of this study was to identify spatial patterns in the incidence of hip fracture in Portugal during the period 2000 to 2002.
From the National Hospital Discharge Register, admissions of patients (50 years of age or more) with low-energy hip fracture were selected. Age-standardized incidence rates in relation to the municipality of the patients’ place of residence were calculated. Empirical Bayes estimators were used to smooth the local risk and spatial statistics methods were used to identify spatial clusters.
Of 25,634 hip fractures in individuals aged 50 years or more caused by low or moderate impact, 19,759 occurred in women (age, mean±SD, 80.6±8.6 years) and 5,875 in men (age 77.7±10.0 years). Incidence rates increased exponentially with age, being higher in women nation-wide (female to male ratio from 1.5 to 5.1). Significant geographic differences were found: the incidence rates (95% CI) varied from 154.4 (153.6–155.3) to 572.2 (569.5–575.0) in women and 77.3 (76.64–78.05) to 231.5 (229.9–233.0) in men per 100,000 inhabitants. Spatial autocorrelation values (Moran index) were 0.56 and 0.45 for women and men, respectively.
Spatial clusters (p<0.0001) of high incidences were identified. Geographic differences in incidence rates were about threefold. Some regions had incidence rates as high as some north European countries. The geographic inequalities could be due to environmental or socioeconomic factors, but further investigation needs to be done to confirm this hypothesis.
KeywordsGeographic information systems Hip fractures Osteoporosis Spatial analysis Spatial clusters Spatial dependency
The authors acknowledge the support of the Portuguese Foundation for Science (grant no. POCI/SAU-ESP/58605/2004).
Conflicts of interest
- 2.Cooper C, Melton LJ III (1996) Magnitude and Impact of osteoporosis and fractures. In: Marcus R, Feldman D, Kelsey J (eds) Osteoporosis. Academic Press, San Diego, pp 419–434Google Scholar
- 9.Kennedy S (1994) The small number problem and the accuracy of spatial databases. In: Goodchild M, Gopal S (eds) Accuracy of spatial databases. Taylor and Francis, London, pp 187–196Google Scholar
- 10.Bailey TC, Gatrell AC (eds) (1995) Interactive spatial data analysis. Longman, LondonGoogle Scholar
- 11.Anselin L (1995) Local indicators of spatial association – LISA. Geogr Anal 27(2):93–115Google Scholar