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Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

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Abstract

Summary

In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women.

Introduction

This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002–2012.

Methods

This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC).

Results

Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, −3.49 (95 % confidence interval (CI), −3.97, −3.01)) compared with the community (APC, −2.93 (95 % CI, −3.28, −2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95 % CI, 1.45, 1.67); men, 2.18 (95 % CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95 % CI, 1.22, 1.80)) and humerus (RR, 1.40 (95 % CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95 % CI, 0.71, 0.81)) and spine (RR, 0.52 (95 % CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95 % CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95 % CI, 0.67, 1.23)) rates were significantly lower in LTC than the community.

Conclusion

Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.

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Notes

  1. This algorithm was chosen as nearly all prescriptions in LTC contain a 30-day supply or less.

  2. Joinpoint Regression Program, version 4.1.1.5—February 2015; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute.

  3. Heteroscedasticity in joinpoint is handled using weighted least squares regression. For model ln(y) = xb, weights are w = (y 2)/v.

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Acknowledgments

This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.

Conflicts of interests

Alexandra Papaioannou received grants/funds from Amgen, Eli Lilly, and Merck, a honoraria from Amgen and Eli Lilly, participated in a speaker forum for Amgen and Eli Lilly, and was a consultant for Amgen and Eli Lilly. Jonathan D. Adachi received grants/funds from Actavis, Amgen, Eli Lilly, Merck, and Novartis, a honoraria from Amgen, Eli Lilly, Merck, and Novartis, participated in a speaker forum for Amgen, Eli Lilly, Merck, and Novartis, acted as a consultant for Amgen, Eli Lilly, Merck, and Novartis, and is a board member for the International Osteoporosis Foundation. Courtney Kennedy, George Ioannidis, Cathy Cameron, Ruth Croxford, Sara Mursleen, and Susan Jaglal have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. GERAS Centre, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada

    A. Papaioannou, C. C. Kennedy, G. Ioannidis & S. Mursleen

  2. Division of Geriatrics, Department of Medicine, McMaster University, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada

    A. Papaioannou & G. Ioannidis

  3. Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    G. Ioannidis & J. D. Adachi

  4. International Centre for Disability and Rehabilitation, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada

    C. Cameron

  5. Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, ON, M5T 3M6, Canada

    R. Croxford

  6. Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada

    S. Jaglal

Authors
  1. A. Papaioannou
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  2. C. C. Kennedy
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  4. C. Cameron
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  6. J. D. Adachi
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  8. S. Jaglal
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Corresponding author

Correspondence to A. Papaioannou.

Appendices

Appendix 1: Description of databases

Discharge Abstract Database

Created by the Canadian Institute for Health Information (CIHI), this database contains demographic, administrative and clinical data records for each inpatient discharge from an acute care hospital. All acute care facilities in Ontario are required to report this information.

National Ambulatory Care Reporting System

Also from CIHI, this database contains data for all hospital-based and community-based ambulatory care including visits to day surgery, outpatient clinics, and emergency departments.

Physician billing claims (Ontario Health Insurance Plan)

This database contains all claims made by physicians for insured services provided to Ontario residents. Records include the type of service provided and diagnostic information. Although not mandatory until 2009, claims for services provided in an institution may have an associated institution number.

Ontario Drug Benefit Plan

This database records all prescriptions paid for under the Ontario Drug Benefit Plan (ODB), which includes all prescriptions for people aged 65 years and older.

Chronic Care Reporting System

This database contains demographic, clinical, functional and resource utilization data for individuals living in continuing care or LTC facilities. During the study period, not all LTC facilities reported patient assessments to the chronic care reporting system (CCRS).

Registered Persons Database

Maintained by the Ministry of Health and Long-Term Care, this database contains basic demographic information (date of birth, sex, postal code) for each healthcare number.

Appendix 2

Table 2 ICD-10-CA diagnosis codes and physician claims codes used to identify osteoporotic fractures in administrative data
Full size table

Appendix 3

Table 3 Annual number of fractures in long-term care seniors aged 65 and older, 2002/2003 to 2012/2013
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Appendix 4

Table 4 Annual number of fractures in community-dwelling seniors aged 65 and older, 2002/2003 to 2012/2013
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Papaioannou, A., Kennedy, C.C., Ioannidis, G. et al. Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012. Osteoporos Int 27, 887–897 (2016). https://doi.org/10.1007/s00198-015-3477-3

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