Abstract
Objective
The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil.
Discussion
We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time—1–30 days, 31–90 days, and 91–365 days after hospital admission—and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge.
Results
We found an overall 21.5% (95% CI 18.2–24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794–1450) and 512.8 (95% CI 366.4–698.3) for the first two periods, 1–30 days and 31–90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99–183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.
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References
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767
Johnell O, Kanis JA (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413
Melton LJ 3rd (1996) Epidemiology of hip fractures: implications of the exponential increase with age. Bone 18:121S–125S
Johnell O, Kanis J (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902
Zethraeus N, Stromberg L, Jonsson B, Svensson O, Ohlen G (1997) The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 68:13–17
Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S; discussion 17S–19S
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882
Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, Rizzoli R (2002) Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int 13:731–737
Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11:460–466
Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M (1996) Epidemiology of hip fractures. Bone 18:57S–63S
Nurmi I, Narinen A, Luthje P, Tanninen S (2003) Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 123:551–554
Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103:20S–25S; discussion 25S–26S
De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10:66–72
Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228
Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525
Lichtblau S (2000) Hip fracture. Surgical decisions that affect medical management. Geriatrics 55:50–56
Jain R, Basinski A, Kreder HJ (2003) Nonoperative treatment of hip fractures. Int Orthop 27:11–17
Lu-Yao GL, Baron JA, Barrett JA, Fisher ES (1994) Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health 84:1287–1291
Lyons AR (1997) Clinical outcomes and treatment of hip fractures. Am J Med 103:51S–63S; discussion 63S–64S
Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636
Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78
Walker N, Norton R, Van der Hoorn S, Rodgers A, MacMahon S, Clark T, Gray H (1999) Mortality after hip fracture: regional variations in New Zealand. N Z Med J 112:269–271
Yuan Z, Dawson N, Cooper GS, Einstadter D, Cebul R, Rimm AA (2001) Effects of alcohol-related disease on hip fracture and mortality: a retrospective cohort study of hospitalized Medicare beneficiaries. Am J Public Health 91:1089–1093
Goldacre MJ, Roberts SE, Yeates D (2002) Mortality after admission to hospital with fractured neck of femur: database study. BMJ 325:868–869
Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA (2005) Survival after hip fracture. Osteoporos Int 16:1583–1590
Franzo A, Francescutti C, Simon G (2005) Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 20:985–991
Karagiannis A, Papakitsou E, Dretakis K, Galanos A, Megas P, Lambiris E, Lyritis GP (2006) Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture. Calcif Tissue Int 78:72–77
Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J (2003) Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 18:2231–2237
Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42
Siqueira FV, Facchini LA, Hallal PC (2005) The burden of fractures in Brazil: a population-based study. Bone 37:261–266
Goldacre MJ, Griffith M, Gill L, Mackintosh A (2002) In-hospital deaths as fraction of all deaths within 30 days of hospital admission for surgery: analysis of routine statistics. BMJ 324:1069–1070
Jaro M (1989) Advances in record-linkage methodology as applied to matching the 1985 Census of Tampa, Florida. J Am Stat Assoc 84:414–420
Jaro M (1995) Probabilistic linkage of large public health data files. Stat Med 14:491–498
Camargo Jr KR, Coeli CM (2000) [Reclink: an application for database linkage implementing the probabilistic record linkage method]. Cad Saude Publica 16:439–447
Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jonsson PV, Poor G, Sisson de Castro JA, Xu L, Matkin CC, Nelson LM, Heyse SP (1999) International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int 9:242–253
Komatsu RS, Simões MFJ, Ramos LR, Szejnfeld VL (1999) Incidência de fraturas de fêmur proximal em Marília, São Paulo, Brasil, 1994 e 1995. Rev Bras Reumat 39:325–331
Silveira VA, Medeiros MM, Coelho-Filho JM, Mota RS, Noleto JC, Costa FS, Pontes FJ, Sobral JB, Aguiar RF, Leal AC, Clemente CM (2005) Hip fracture incidence in an urban area in Northeast Brazil. Cad Saude Publica 21:907–912
Castro da Rocha FA, Ribeiro AR (2003) Low incidence of hip fractures in an equatorial area. Osteoporos Int 14:496–499
Roberts SE, Goldacre MJ (2003) Time trends and demography of mortality after fractured neck of femur in an English population, 1968–98: database study. BMJ 327:771–775
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473
Krieger N, Davey Smith G (2004) “Bodies count,” and body counts: social epidemiology and embodying inequality. Epidemiol Rev 26:92–103
Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT (2002) Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am J Public Health 92:858–862
Meyer HE, Tverdal A, Falch JA, Pedersen JI (2000) Factors associated with mortality after hip fracture. Osteoporos Int 11:228–232
Katelaris AG, Cumming RG (1996) Health status before and mortality after hip fracture. Am J Public Health 86:557–560
Tjeenk R, Shepers A, van de Linde P, Breslau P, Peeters M (2002) Mortality registration in patients with a proximal femoral fracture admitted to a surgical ward. Eur J Trauma 28:95–99
Poole KE, Reeve J, Warburton EA (2002) Falls, fractures, and osteoporosis after stroke: time to think about protection? Stroke 33:1432–1436
Handoll HH, Sherrington C, Parker MJ (2005) Mobilisation strategies after hip fracture surgery in adults. The Cochrane Library, issue 2. Update Software, Oxford
Seiler W (2000) Consequences of immobility. In: Evans JG (ed) Oxford textbook of geriatric medicine. Oxford University Press, Oxford, pp 1175–1181
Kane R, Ouslander, J, Abrass I (2003) Immobility. In: Kane R, Ouslander J, Abrass I (eds) Essentials of clinical geriatrics. McGraw-Hill, New York, pp 245–277
Browner WS, Seeley DG, Vogt TM, Cummings SR (1991) Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet 338:355–358
Johansson C, Black D, Johnell O, Oden A, Mellstrom D (1998) Bone mineral density is a predictor of survival. Calcif Tissue Int 63:190–196
Hamerman D (2005) Osteoporosis and atherosclerosis: biological linkages and the emergence of dual-purpose therapies. QJM 98:467–484
Nawroth P, Pirzer R, Fohr B, Schilling T, Ziegler R, Bierhaus A, Kasperk C (2003) [Osteoporosis and cardiovascular disease-two sides of the same coin?]. Med Klin (Munich) 98:437–446
Strausbaugh L (2001) Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 7:268–271
Falsey AR (2000) Epidemiology of infectious diseases. In: Evans JG (ed) Oxford textbook of geriatric medicine. Oxford University Press, Oxford, pp 55–64
Colón-Emeric C, Sloane R, Hawkes W, Magaziner J, Zimmerman S, Pieper C, Lyles K (2000) The risk of subsequent fracture in community-dwelling men and male veterans with hip fracture. Am J Med 109:324–326
[No authors listed] (1995) Computerised record linkage: compared with traditional patient follow-up methods in clinical trials and illustrated in a prospective epidemiological study. The West of Scotland Coronary Prevention Study Group. J Clin Epidemiol 48:1441–1452
Shannon HS, Jamieson E, Walsh C, Julian JA, Fair ME, Buffet A (1989) Comparison of individual follow-up and computerized record linkage using the Canadian Mortality Data Base. Can J Public Health 80:54–57
Partanen J, Syrjala H, Vahanikkila H, Jalovaara P (2006) Impact of deep infection after hip fracture surgery on function and mortality. J Hosp Infect 62:44–49
Levcovitz E, Pereira T (1993) Uma Ánalise do Sistema Público de Remuneração de Internações Hospitalares. Série Est Saúde Col UERJ 57:1–83
Castro MSM, Travassos C, Carvalho MS (2002) [Analysis of hospital admissions associated factors in Brazil]. Ciênc Saúde Coletiva 7:795–811
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Funding
This project was sponsored by the Brazilian National Council for Scientific and Technological Development (CNPq), Edital CNPq 19/2004, (471562/2004-1).
Appendix
Appendix
Here we list some software packages that implement some or all of the procedures of the PRL methodology:
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FEBRL (Freely Extensible Biomedical Record Linkage): flexible linkage system from Australia based on Python scripts. http://sourceforge.net/projects/febrl/
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Link Plus: linkage module for U.S. cancer registries but suitable for wider purposes. http://www.cdc.gov/cancer/registryplus/lp.htm
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The Link King: requires an SAS software installation. http://www.the-link-king.com/
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Identity Search Server. http://www.identitysystems.com/
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Merge Tool Box: German linkage software (work in progress; the probabilistic linkage module is not available yet). http://www.uni-konstanz.de/FuF/Verwiss/Schnell/recordli.html
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RecLink: Two of us (K.R.C. and C.M.C.) have been developing over the years a freely distributed application (currently available in Portuguese only), which can be downloaded from the following address: http://paginas.terra.com.br/educacao/kencamargo/rlx.zip. A new version is under heavy development now (still in Portuguese) and is expected to be released in the first half of this year. An English version is now under consideration.
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Vidal, E.I.O., Coeli, C.M., Pinheiro, R.S. et al. Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil. Osteoporos Int 17, 1569–1576 (2006). https://doi.org/10.1007/s00198-006-0173-3
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DOI: https://doi.org/10.1007/s00198-006-0173-3