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Traumatic fractures in China from 2012 to 2014: a National Survey of 512,187 individuals

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Abstract

Summary

The China National Fracture Study has been conducted to provide a national dataset of traumatic fractures across China. A national representative sample of 512,187 individuals was selected. The population-weighted incidence rates, distribution, injury mechanisms, and risk factors for traumatic fractures were identified for various groups of individuals.

Introduction

The China National Fracture Study (CNFS) has been conducted to provide a comprehensive and up-to-date national dataset of traumatic fractures across China. This study aims to report the national incidences and distributions of traumatic fractures that occurred in 2012, 2013, and 2014 and to analyze the risk factors.

Methods

A national representative sample of individuals was selected from 24 rural counties and 24 urban cities of 8 provinces using stratified random sampling and the probability proportional to size (PPS) methodology. Participants were interviewed to identify whether they sustained traumatic fractures of the trunk and/or four extremities that had occurred in 2012, 2013, and 2014. The main risk factors associated with traumatic fractures were analyzed by multiple logistic regression models.

Results

A total of 512,187 individuals, including 259,649 males and 252,538 females, participated in the CNFS. The population-weighted incidence rates of traumatic fractures in China were calculated to be 2.5 (95% CI, 2.2–2.8) per 1000 population in 2012, 2.8 (95% CI, 2.5–3.3) in 2013, and 3.2% (95% CI, 2.8–3.6) in 2014. The population-weighted incidence rates of fragility fractures among participants aged 65 years and older were calculated to be 27.4 (95% CI, 21.4–33.4) per 1000 population in 2012, 36.0 (95% CI, 28.6–43.5) in 2013, and 42.4 (95% CI, 34.9–49.9) in 2014. The most common cause of fracture was low-energy injuries, followed by traffic accidents. For all age groups, sleeping less than 7 h was a risk factor for traumatic fractures. Alcohol consumption and previous fracture history were identified as risk factors for adults aged 15 years and over. Cigarette smoking was found to be a risk factor for males aged 15–64 years old. For individuals aged 15–64 years old, underweight incurred a risk effect for males and overweight for females. Alcohol consumption, sleeping less than 7 h per day, living in the central and eastern regions, a body mass index less of than 18.5, and having a previous fracture history were identified as strong risk factors for fragility fractures.

Conclusion

The national incidence, distribution, and injury mechanisms for traumatic fractures were revealed in the CNFS. Risk factors were identified for various groups of individuals.

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Acknowledgments

The authors would like to thank Guang Zeng, Ruotao Wang, Hongbing Shen, Dongqing Ye, Dianwu Liu, Qingbao Tian, Xu Liu, and Derek Smith for their valuable advice regarding the study design and data analysis. The authors would also like to acknowledge the CNFS team members.

Funding

This study was supported by the Hebei Province Medical Science Special Major Projects Research Fund (2015-03) and Hebei Science Foundation-Outstanding Youth Foundation (Grand No. H2017206104). The funding sources have no role in study design, conduction, data collection, data analysis, interpretation, and preparation of the manuscript.

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Author notes

  1. H. Lv, W. Chen, T. Zhang, Z. Hou, G. Yang, Y. Zhu, H. Wang, B. Yin, J. Guo and L. Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, China

    H. Lv, W. Chen, T. Zhang, Z. Hou, G. Yang, Y. Zhu, H. Wang, B. Yin, J. Guo, L. Liu, P. Hu, S. Liu, B. Liu, J. Sun, S. Li & Y. Zhang

  2. Department of Epidemiology and Statistics, Hebei Medical University, Shijiazhuang, China

    X. Zhang

  3. Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, 518057, China

    Y. Li

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  1. H. Lv
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Corresponding author

Correspondence to Y. Zhang.

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Ethics committee approval

This study has been approved by the Institutional Review Board of The Third Hospital of Hebei Medical University and registered on the Chinese Clinical Trial Registry (Registration number: ChiCTR-EPR-15005878).

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Written informed consent was obtained from each participant prior to data collection.

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Lv, H., Chen, W., Zhang, T. et al. Traumatic fractures in China from 2012 to 2014: a National Survey of 512,187 individuals. Osteoporos Int 31, 2167–2178 (2020). https://doi.org/10.1007/s00198-020-05496-9

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  • DOI: https://doi.org/10.1007/s00198-020-05496-9

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