Abstract
Summary
China is experiencing remarkable changes in people aging and migration. Therefore, the incidence and associated factors for hip fracture might differ from previous results. A nationally representative study of hip fracture enables policymakers to formulate preventive strategies and provide information on resource allocation.
Purpose
To estimate the incidence of hip fracture, between 2013 and 2015, among the middle-aged and older Chinese population.
Methods
Individuals with hip fractures between 2013 and 2015 were identified from the China Health and Retirement Longitudinal Study. The sex-specific incidence and the associated factors of hip fracture were assessed.
Results
Among 19,112 individuals (51.4% women; mean age 60.5 years) included in the analysis, 408 (2.13%) had a hip fracture between 2013 and 2015. Moreover, the annual incidence of hip fracture for men and women were 1065 and 1069 per 100,000, respectively. The incidence of hip fracture increased with age (p < 0.001). A history of chronic disease, being unmarried, and individuals without insurance were associated with a higher incidence of hip fracture. Interestingly, the incidence of hip fracture was higher among individuals with fewer years of education (p = 0.002). The North-East regions of China had the lowest incidence of hip fracture (1022 per 100,000) between 2013 and 2015, followed by the North (1602 per 100,000), South-Central (2055 per 100,000), East (2173 per 100,000), and South-West (2537 per 100,000) regions. Finally, the incidence was highest among participants living in the North-West region (3244 per 100,000).
Conclusion
Between 2013 and 2015, the incidence of hip fracture is high among the middle-aged and older Chinese population. Furthermore, it varied significantly according to sociodemographic and geographic factors. Therefore, the support of targeted health policies and cost-effective preventive strategies are warranted in China.
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Data availability
Details of how to access the CHARLS data and details of the data release schedule are available from http://charls.pku.edu.cn/index/zh-cn.html.
Code availability
Not applicable.
References
Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H (2014) Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol 10:338–351
Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390
Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902
(2020) Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet (London, England) 395:698–708
Downey C, Kelly M, Quinlan JF (2019) Changing trends in the mortality rate at 1-year post hip fracture - a systematic review. World J Orthop 10:166–175
Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288
(2020) GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England) 396:1204-1222
GBD Compare tool: Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Available from https://vizhub.healthdata.org/gbd-compare/. Accessed 11 Aug 2021
Swayambunathan J, Dasgupta A, Rosenberg PS, Hannan MT, Kiel DP, Bhattacharyya T (2020) Incidence of hip fracture over 4 decades in the Framingham Heart Study. JAMA Intern Med 180:1225–1231
Leslie WD, O’Donnell S, Jean S, Lagacé C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889
Nilson F, Moniruzzaman S, Gustavsson J, Andersson R (2013) Trends in hip fracture incidence rates among the elderly in Sweden 1987–2009. J Public Health (Oxf) 35:125–131
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413
United nations, Department of Economic and Social Affairs, Population Division. World population prospects 2019: highlights. Online edition, 2019. Available from: https://www.un.org/development/desa/publications/world-population-prospects-2019-highlights.html. Accessed 7 Aug 2021
National Bureau of Statistics. Communique of the Seventh National Census (No. 5). 05–11, 2021.Available from: http://www.stats.gov.cn/tjsj/zxfb/202105/t20210510_1817181.html. Accessed 07, August, 2021.
Chen JS, Sambrook PN, Simpson JM, Cameron ID, Cumming RG, Seibel MJ, Lord SR, March LM (2009) Risk factors for hip fracture among institutionalised older people. Age Ageing 38:429–434
Yoo JI, Kim HY, Jang S, Lee YK, Ha YC (2020) Risk factors for subsequent hip fractures and fatality after an initial hip fracture in Korea: using nationwide claims data. Arch Osteoporos 15:165
Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, Wang O, Xing XP, Sun Y, Cummings SR (2012) Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res 27:125–129
Hou XL, Liu JY, Fan XH et al (2022) Secular trends of incidence and hospitalization cost of hip fracture in Tangshan, China. Osteoporos Int 33(1):89–96
Banerjee G, Zullo AR, Berry SD, Lee Y, McConeghy K, Kiel DP, Mor V (2016) Geographic variation in hip fracture among United States long-stay nursing home residents. J Am Med Dir Assoc 17:865.e861–863
Zhao Y, Hu Y, Smith JP, Strauss J, Yang G (2014) Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 43:61–68
Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302:1573–1579
Tamaki J, Fujimori K, Ikehara S, Kamiya K, Nakatoh S, Okimoto N, Ogawa S, Ishii S, Iki M, for the Working Group of Japan Osteoporosis F (2019) Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012–2015. Osteoporos Int 30:975–983
Zhang C, Feng J, Wang S, et al (2020) Incidence of and trends in hip fracture among adults in urban China: a nationwide retrospective cohort study. PLoS Med 17:e1003180
Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P (2019) Epidemiology of hip fractures : systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr 52:10–16
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet (London, England) 359:1761–1767
Li X, Zhang W, Zhang W, Tao K, Ni W, Wang K, Li Z, Liu Q, Lin J (2020) Level of physical activity among middle-aged and older Chinese people: evidence from the China health and retirement longitudinal study. BMC Public Health 20:1682
Marks R, Allegrante JP, Ronald MacKenzie C, Lane JM (2003) Hip fractures among the elderly: causes, consequences and control. Ageing Res Rev 2:57–93
Pisani P, Renna MD, Conversano F, Casciaro E, Di Paola M, Quarta E, Muratore M, Casciaro S (2016) Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop 7:171–181
Robards J, Evandrou M, Falkingham J, Vlachantoni A (2012) Marital status, health and mortality. Maturitas 73:295–299
Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20:1487–1497
Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark. Scand J Public Health 34:371–377
Wilson RT, Chase GA, Chrischilles EA, Wallace RB (2006) Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators. Am J Public Health 96:1210–1218
Prieto-Alhambra D, Turkiewicz A, Reyes C, Timpka S, Rosengren B, Englund M (2020) Smoking and alcohol intake but not muscle strength in young men increase fracture risk at middle age: a cohort study linked to the Swedish National Patient Registry. J Bone Miner Res 35:498–504
Laaksonen M, Talala K, Martelin T, Rahkonen O, Roos E, Helakorpi S, Laatikainen T, Prättälä R (2008) Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years. Eur J Public Health 18:38–43
Ralston SH, Uitterlinden AG (2010) Genetics of osteoporosis. Endocr Rev 31:629–662
Pekkarinen T, Löyttyniemi E, Välimäki M (2013) Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women. Osteoporos Int 24:2983–2992
Espinosa R, Clark P, Denova-Gutiérrez E et al (2018) Prevention of low bone mass to achieve high bone density in Mexico: position of the Mexican Association for Bone and Mineral Metabolism. Arch Osteoporos 13:105
Ensrud KE, Crandall CJ (2017) Osteoporosis. Annals Int Med 167:Itc17-itc32
LeBlanc KE, Muncie HL Jr, LeBlanc LL (2014) Hip fracture: diagnosis, treatment, and secondary prevention. Am Fam Physician 89:945–951
de Bot R, Veldman HD, Witlox AM, van Rhijn LW, Hiligsmann M (2020) Hip protectors are cost-effective in the prevention of hip fractures in patients with high fracture risk. Osteoporos Int 31:1217–1229
Acknowledgements
We would like to acknowledge the China Health and Retirement Longitudinal Study (CHARLS) team for providing high quality, nationally representative data.
Funding
This work was supported by the Beijing Postdoctoral Research Foundation of China (Grant Number: 2021-ZZ-010),the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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AG, HL, and FY designed the study. HL, RC, HZ, and YQ analyzed the data. HL and RC wrote the manuscript. HL, RC, HZ, YQ, HYY, HMY, LM, and ND participated in the data collection, analysis, and interpretation. All authors read and approved the final manuscript.
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CHARLS has been approved by the Ethical Review Committee of Peking University, and all participants signed informed consent at the time of participation. Therefore, no separate ethical approval was required for our study.
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Long, H., Cao, R., Zhang, H. et al. Incidence of hip fracture among middle-aged and older Chinese from 2013 to 2015: results from a nationally representative study. Arch Osteoporos 17, 48 (2022). https://doi.org/10.1007/s11657-022-01082-0
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DOI: https://doi.org/10.1007/s11657-022-01082-0