Pre-fracture individual characteristics associated with high total health care costs after hip fracture
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Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted.
The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims.
Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture.
Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed <0.6 m/s compared to ≥1.0 m/s, 25 % higher ($9601, 95 % CI $3314 to $16,069) in those with body mass index ≥30 kg/m2 compared to 20 to 24.9 mg/kg2, and 21 % higher ($7936, 95 % CI $346 to $15,526) for those with seven or more compared to no comorbid medical conditions.
Pre-fracture poor mobility, obesity, and multiple comorbidities are associated with higher total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.
KeywordsHip fracture costs Multimorbidity Obesity Total health care costs Walk speed
We are grateful for the assistance of David Van Riper, the Director Spatial Analysis at the Minnesota Population Center, and M. Taylor Long of the Spatial Analysis Unit, who calculated the distances from study participants’ residences to skill nursing facilities.
This manuscript is also the result of work supported in part with resources and use of facilities at the Minneapolis VA Health Care System. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the US government.
Compliance with ethical standards
This study was done primarily under funding from the National Institute for Aging/National Institutes of Health, primarily grant number R01 AG038415-01. The Study of Osteoporotic Fractures is also supported by the National Institute for Aging under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576.
Role of sponsor
The sponsor had no role in the study concept and design, data collection or analysis, or drafting or reviewing the manuscript.
Conflicts of interest
Dr. Ensrud serves as a consultant on a Data Monitoring Committee for Merck Sharpe & Dohme. Authors John T. Schousboe, Misti L. Paudel, Brent C. Taylor, Allyson M Kats, Beth A. Virnig, Bryan E. Dowd, and Lisa Langsetmo all have nothing to disclose.
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