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Vaccination against COVID-19 reduced the mortality risk of COVID-positive hip fracture patients to baseline levels: the nationwide data-linked IMPACT Protect study

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Abstract

Summary

This nationwide study used data-linked records to assess the effect of COVID-19 vaccination among hip fracture patients. Vaccination was associated with a lower risk of contracting COVID-19 and, among COVID-positive patients, it reduced the mortality risk to that of COVID-negative patients. This provides essential data for future communicable disease outbreaks.

Purpose

COVID-19 confers a three-fold increased mortality risk among hip fracture patients. The aims were to investigate whether vaccination was associated with: i) lower mortality risk, and ii) lower likelihood of contracting COVID-19 within 30 days of fracture.

Methods

This nationwide cohort study included all patients aged > 50 years that sustained a hip fracture in Scotland between 01/03/20–31/12/21. Data from the Scottish Hip Fracture Audit were collected and included: demographics, injury and management variables, discharge destination, and 30-day mortality status. These variables were linked to government-managed population level records of COVID-19 vaccination and laboratory testing.

Results

There were 13,345 patients with a median age of 82.0 years (IQR 74.0–88.0), and 9329/13345 (69.9%) were female. Of 3022/13345 (22.6%) patients diagnosed with COVID-19, 606/13345 (4.5%) were COVID-positive within 30 days of fracture. Multivariable logistic regression demonstrated that vaccinated patients were less likely to be COVID-positive (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.34–0.48, p < 0.001) than unvaccinated patients. 30-day mortality rate was higher for COVID-positive than COVID-negative patients (15.8% vs 7.9%, p < 0.001). Controlling for confounders (age, sex, comorbidity, deprivation, pre-fracture residence), unvaccinated patients with COVID-19 had a greater mortality risk than COVID-negative patients (OR 2.77, CI 2.12–3.62, p < 0.001), but vaccinated COVID19-positive patients were not at increased risk of death (OR 0.93, CI 0.53–1.60, p = 0.783).

Conclusion

Vaccination was associated with lower COVID-19 infection risk. Vaccinated COVID-positive patients had a similar mortality risk to COVID-negative patients, suggesting a reduced severity of infection. This study demonstrates the efficacy of vaccination in this vulnerable patient group, and presents data that will be valid in the management of future outbreaks.

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Data Availability

This study utilized data from databases controlled by a public health agency, therefore these data have not been made publicly available.

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Acknowledgements

The authors would like to thank Karen Adam (Scottish Government), Kirsty Ward, Stuart Baird, and Caroline Martin (Public Health Scotland), and all members of the Scottish Hip Fracture Audit.

Funding

Nil.

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Authors and Affiliations

  1. Golden Jubilee Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK

    Andrew J. Hall

  2. School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK

    Andrew J. Hall

  3. National Treatment Centre – Fife Orthopaedics, NHS Fife, Kirkcaldy, UK

    Andrew J. Hall

  4. Scottish Hip Fracture Audit (SHFA), NHS National Services Scotland, Edinburgh, UK

    Andrew J. Hall, N. D. Clement & A. M. J. MacLullich

  5. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK

    N. D. Clement, T. O. White & A. D. Duckworth

  6. Ageing & Health Group, Usher Institute, University of Edinburgh, Edinburgh, UK

    A. M. J. MacLullich

  7. Scottish Orthopaedic Research Trust Into Trauma (SORT-IT), Edinburgh, UK

    N. D. Clement, T. O. White & A. D. Duckworth

  8. Department of Orthopaedics & Trauma and Usher Institute, University of Edinburgh, Edinburgh, UK

    A. D. Duckworth

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Correspondence to Andrew J. Hall.

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Hall, A.J., Clement, N.D., MacLullich, A.M.J. et al. Vaccination against COVID-19 reduced the mortality risk of COVID-positive hip fracture patients to baseline levels: the nationwide data-linked IMPACT Protect study. Osteoporos Int 35, 353–363 (2024). https://doi.org/10.1007/s00198-023-06954-w

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  • DOI: https://doi.org/10.1007/s00198-023-06954-w

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