Advertisement

Osteoporosis International

, Volume 28, Issue 1, pp 161–168 | Cite as

The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location, and ethnicity

  • C. Klop
  • T. P. van Staa
  • C. CooperEmail author
  • N. C. Harvey
  • F. de Vries
Original Article

Abstract

Summary

One-year mortality following a fracture was greater for men compared to women, varied markedly between regions in England with the lowest rates in the London region, and was higher among black women compared to white women. The excess in mortality did not change during the study period.

Introduction

Fractures are associated with increased mortality. With the shift towards an increasingly elderly demography, and so increasing numbers of fractures, the impact of such events on mortality is of key public health importance. Therefore, we aimed to present up-to-date mortality rates following fracture in England.

Methods

This was a population-based study within the Clinical Practice Research Datalink, linked to death certificates (1 January 2001 to 31 December 2011). Subjects were followed from their first fracture (hip, wrist, humerus, clinical spine, ribs, or pelvis) until death for up to 1 year. Rate ratios (RRs) were estimated for 1-year mortality, stratified by sex, 5-year age categories, ethnicity, and geographical region. Excess mortality was presented as standardized mortality ratios (SMRs).

Results

One-year mortality following fracture increased with age and was higher for men than women. Black women (RR 1.77; 95 % CI 1.00–3.12) and women of “other” ethnicity (RR 1.59, 95 % CI 1.16–2.16) were at higher risk of death when compared to white women. Mortality was higher among women in almost all regions when compared to the London region, with the highest risk in the East Midlands (37 % higher). The 1-year mortality risk was more than 3-fold higher after fracture as compared to the general population (adjusted SMR: 3.15, 95 % CI 3.09–3.26) and did not change during the study period. Major causes of death were neoplasms, respiratory diseases, and circulatory diseases.

Conclusion

This study provides up-to-date mortality outcomes following fracture in England and will aid allocation of healthcare provision to those at greatest need.

Keywords

Comorbidity Epidemiology Mortality Osteoporosis 

Notes

Acknowledgments

The work was supported by a grant from the National Osteoporosis Society. This work was further supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford.

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

198_2016_3787_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 28 kb)
198_2016_3787_MOESM2_ESM.docx (29 kb)
ESM 2 (DOCX 28 kb)
198_2016_3787_MOESM3_ESM.docx (28 kb)
ESM 3 (DOCX 27 kb)

References

  1. 1.
    Van Staa TP, Dennison EM, Leufkens HGM, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522CrossRefPubMedGoogle Scholar
  2. 2.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521CrossRefPubMedGoogle Scholar
  3. 3.
    Morin S, Lix LM, Azimaee M, Metge C, Caetano P, Leslie WD (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448CrossRefPubMedGoogle Scholar
  4. 4.
    Huntjens KMB, Kosar S, van Geel TACM, Geusens PP, Willems P, Kessels A et al (2010) Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos Int 21:2075–2082CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Haentjens P, Magaziner J, Colón-Emeric CS, van der Schueren D, Milisen K, Velkeniers B et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Klop C, Welsing PMJ, Cooper C, Harvey NC, Elders PJM, Bijlsma JWJ et al (2014) Mortality in British hip fracture patients, 2000-2010: a population-based retrospective cohort study. Bone 66:171–177CrossRefPubMedGoogle Scholar
  7. 7.
    Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, Smeeth L (2015) Data resource profile: clinical practice research datalink (CPRD). Int J Epidemiol 44:827–836CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Van Staa TP, Abenhaim L, Cooper C, Zhang B, Leufkens HG (2000) The use of a large pharmacoepidemiological database to study exposure to oral glucocorticoids and risk of fractures: validation of study population and results. Pharmacoepidemiol Drug Saf 9:359–366CrossRefPubMedGoogle Scholar
  10. 10.
    Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ (2010) Validation and validity of diagnoses in the general practice research database: a systematic review. Br J Clin Pharmacol 69:4–14CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Khan NF, Harrison SE, Rose PW (2010) Validity of diagnostic coding within the general practice research database: a systematic review. Br J Gen Pract 60:e128–e136CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lewis JD, Brensinger C (2004) Agreement between GPRD smoking data: a survey of general practitioners and a population-based survey. Pharmacoepidemiol Drug Saf 13:437–441CrossRefPubMedGoogle Scholar
  13. 13.
    Gallagher AM, Puri S, van Staa TP (2011) Linkage of the general practice research database (GPRD) with other data sources. Pharmacoepidemiol Drug Saf 20:S230Google Scholar
  14. 14.
    Rothman KJ, Greenland S (eds) (1998) Modern epidemiology, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  15. 15.
    Bliuc D, Nguyen TV, Eisman JA, Center JR (2014) The impact of nonhip nonvertebral fractures in elderly women and men. J Clin Endocrinol Metab 99:415–423CrossRefPubMedGoogle Scholar
  16. 16.
    Sattui SE, Saag KG (2014) Fracture mortality: associations with epidemiology and osteoporosis treatment. Nat Rev Endocrinol 10:592–602CrossRefPubMedGoogle Scholar
  17. 17.
    Roche JJW, Wenn RT, Sahota O, Mora CG Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. doi: 10.1136/bmj.38643.663843.55 Published 18 November 2005
  18. 18.
    Sterling RS (2011) Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function. Clin Orthop Relat Res 469:1913–1918CrossRefPubMedGoogle Scholar
  19. 19.
    Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ et al (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63:867–872CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1992) Race and sex differences in mortality following fracture of the hip. Am J Public Health 82:1147–1150CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    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 84:1287–1291CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Sullivan KJ, Husak LE, Altebarmakian M, Brox WT (2016) Demographic factors in hip fracture incidence and mortality rates in California, 2000-2011. J Orthop Surg Res 11:4CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hoenig H, Rubenstein L, Kahn K (1996) Rehabilitation after hip fracture—equal opportunity for all? Arch Phys Med Rehabil 77:58–63CrossRefPubMedGoogle Scholar
  24. 24.
    Harada ND, Chun A, Chiu V, Pakalniskis A (2000) Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities. Med Care 38:1119–1130CrossRefPubMedGoogle Scholar
  25. 25.
    Office of National Statistics (2014) Statistical bulletin: deaths registered in England and WalesGoogle Scholar
  26. 26.
    TY W, Jen MH, Bottle A, Liaw CK, Aylin P, Majeed A (2010) Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health (Oxf) 33:284–291Google Scholar
  27. 27.
    Chau PH, Wong M, Lee A, Ling M, Woo J (2013) Trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001-2009. Age Ageing 42:229–233CrossRefPubMedGoogle Scholar
  28. 28.
    Gordon J, Pham CT, Karnon J, Crotty M (2012) Monitoring progress in the management of hip frcture in South Australia, Australia. Arch Osteoporos 7:267–273CrossRefPubMedGoogle Scholar
  29. 29.
    Brauer CA, Coca-Perraillon M, Cutlet DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Huntjens KMB, van Geel TACM, van den Bergh JPW, van Helden S, Willems P et al (2014) Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am 96:e29 1-8CrossRefPubMedGoogle Scholar
  31. 31.
    Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH et al (2015) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF capture the fracture best practice framework tool. Osteoporos Int 26:2573–2578CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of ScienceUtrecht UniversityUtrechtThe Netherlands
  2. 2.Health eResearch Centre, Farr Institute for Health Informatics ResearchUniversity of ManchesterManchesterUK
  3. 3.MRC Lifecourse Epidemiology Unit, University of SouthamptonSouthampton General HospitalSouthamptonUK
  4. 4.NIHR Musculoskeletal Biomedical Research UnitUniversity of OxfordOxfordUK
  5. 5.NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
  6. 6.Department of Clinical Pharmacy and ToxicologyMaastricht University Medical Centre+MaastrichtThe Netherlands
  7. 7.Department of Epidemiology, Care and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands

Personalised recommendations