Abstract
Summary
A register-based study including 2,674 first hip fracture patients from 1987–1996 investigated if the mortality after hip fracture was associated with time trend and fracture type. Despite significantly increasing age at admission no changing time trend of mortality was observed, nor was the mortality linked to the kind of fracture suffered.
Introduction and hypothesis
A retrospective cohort study was performed to investigate if the mortality of first hip fracture patients was associated with time trend and fracture type. The hypotheses were that cumulative mortality would remain unchanged and there would be no difference in mortality between cervical and pertrochanteric patients.
Methods
Study material was obtained by record linkage of excerpts from two computerized national health registers. First hip fractures were identified indirectly by searching the files ten years before the date of admission. The period 1987–1996 saw inclusion of 2,674 patients aged 50 years and older (average follow-up 2.6 years). Statistics: Weighted regression analysis, χ 2 test, and t test.
Results
Cumulative mortality did not change significantly (P > 0.05). Weighted average cumulative mortality was 9% (95% CI, 7.9–10.1) at 1 month, 15.5% (95% CI, 14.1–16.8) at 3 months, 26.5% (95% CI, 24.7–28.3) at 1 year, and 36.2% (95% CI, 34.1–38.3) at 2 years. Cervical and pertrochanteric first hip fracture patients did not have significantly different mortality rates (P > 0.05).
Conclusion
No changing time trend of mortality after first hip fracture was observed despite significantly increasing age at admission, nor was the mortality linked to the kind of fracture suffered.
Similar content being viewed by others
References
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413
Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M (1996) Epidemiology of hip fractures. Bone 18(Suppl 1):57S–63S
Johnell O, Kanis JA (2004) An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 15:897–902
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
Schroder HM (1991) The cost of hospitalizing hip fracture patients has increased despite shorter hospitalization time. Injury 22:135–138
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
Zethraeus N, Gerdtham UG (1998) Estimating the costs of hip fracture and potential savings. Int J Technol Assess Health Care 14:255–267
Melton LJ 3rd, Therneau TM, Larson DR (1998) Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival. Osteoporos Int 8:68–74
Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am 77:1551–1556
McColl A, Roderick P, Cooper C (1998) Hip fracture incidence and mortality in an English Region: a study using routine National Health Service data. J Public Health Med 20:196–205
Fisher ES, Baron JA, Malenka DJ, Barrett JA, Kniffin WD, Whaley FS et al (1991) Hip fracture incidence and mortality in New England. Epidemiology 2:116–122
Bredahl C, Nyholm B, Hindsholm KB, Mortensen JS, Olesen AS (1992) Mortality after hip fracture: results of operation within 12 h of admission. Injury 23:83–86
Schroder HM, Erlandsen M (1993) Age and sex as determinants of mortality after hip fracture: 3,895 patients followed for 2.5–18.5 years. J Orthop Trauma 7:525–531
Jensen JS, Tondevold E (1979) Mortality after hip fractures. Acta Orthop Scand 50:161–167
Stavrou ZP, Erginousakis DA, Loizides AA, Tzevelekos SA, Papagiannakos KJ (1997) Mortality and rehabilitation following hip fracture. A study of 202 elderly patients. Acta Orthop Scand Suppl 275:89–91
White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg Am 69:1335–1340
Wolinsky FD, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87:398–403
Kreutzfeldt J, Haim M, Bach E (1984) Hip fracture among the elderly in a mixed urban and rural population. Age Ageing 13:111–119
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
Boereboom FT, Raymakers JA, Duursma SA (1992) Mortality and causes of death after hip fractures in The Netherlands. Neth J Med 41:4–10
Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M (2003) Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. J Clin Epidemiol 56:788–795
Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA, Swedish Hip Fracture Study Group (2005) Survival after hip fracture. Osteoporos Int 16:1583–1590
Meyer HE, Tverdal A, Falch JA, Pedersen JI (2000) Factors associated with mortality after hip fracture. Osteoporos Int 11:228–232
Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS et al (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87:1630–1636
Muraki S, Yamamoto S, Ishibashi H, Nakamura K (2006) Factors associated with mortality following hip fracture in Japan. J Bone Miner Metab 24:100–104
Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ (2003) Mortality risk after hip fracture. J Orthop Trauma 17:53–56
Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250
Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL (2004) Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res 425:64–71
Hannan EL, Magaziner J, Wang JJ, Eastwood EA, Silberzweig SB, Gilbert M et al (2001) Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 285:2736–2742
Kotzan JA, Martin BC, Reeves JH, Wade W (1999) The impact of race and fractures on mortality in a postmenopausal Medicaid population. Clin Ther 21:1988–2000
Eiskjaer S, Ostgard SE, Jakobsen BW, Jensen J, Lucht U (1992) Years of potential life lost after hip fracture among postmenopausal women. Acta Orthop Scand 63:293–296
Parker MJ, Anand JK (1991) What is the true mortality of hip fractures? Public Health 105:443–446
Giversen IM (2006) Time trends of age-adjusted incidence rates of first hip fractures: a register-based study among older people in Viborg County, Denmark, 1987–1997. Osteoporos Int 7:552–564
Schroder HM, Petersen KK, Erlandsen M (1993) Occurrence and incidence of the second hip fracture. Clin Orthop 289:166–169
Madhok R, Melton LJ 3rd, Atkinson EJ, O’Fallon WM, Lewallen DG (1993) Urban vs rural increase in hip fracture incidence. Age and sex of 901 cases 1980–89 in Olmsted County, U.S.A. Acta Orthop Scand 64:543–548
Endo Y, Aharonoff GB, Zuckerman JD, Egol KA, Koval KJ (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 19:29–35
Foss NB, Kehlet H (2005) Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 94:24–29
Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42
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
Mosbech J, Jorgensen J, Madsen M, Rostgaard K, Thornberg K, Poulsen TD (1995) The national patient registry. Evaluation of data quality. Ugeskr Laeger 157:3741–3745
Jurgensen HJ, Frolund C, Gustafsen J, Mosbech H, Guldhammer B (1984) Registration of diagnoses in a national patient register. Preliminary assessment of the validity of the register. Ugeskr Laeger 146:3303–3308
Wille-Jorgensen PA, Meisner S (1997) The validity of data in registration of operations. A quality analysis. Ugeskr Laeger 159:7328–7330
Juel K, Helweg-Larsen K (1999) The Danish registers of causes of death. Dan Med Bull 46:354–357
Storm HH, Michelsen EV, Clemmensen IH, Pihl J (1997) The Danish Cancer Registry-history, content, quality and use. Dan Med Bull 44:535–539
Schroder HM, Andreassen MD, Villadsen I, Sorensen JG, Erlandsen M (1995) Increasing age-specific incidence of hip fractures in a Danish municipality. Dan Med Bull 42:109–111
Statistics Denmark. Tabel 30. Middellevetid efter doedelighedserfaringerne (Table 30. Mean life expectancy according to the mortality experiences). Available at: http://www.statistikbanken.dk, Accessed August 28, 2006
Bronnum-Hansen H (2005) Health expectancy in Denmark, 1987–2000. Eur J Public Health 15:20–25
Statistics Denmark. Population statistics. Available at: http://www.statistikbanken.dk, Accessed July 23, 2006
Grants and Acknowledgments
This study was conducted as a part of my education at the Master of Public Health Program at Aarhus University. Professor Michael Vaeth, PhD, Department of Biostatistics, University of Aarhus, was my advisor and provided statistical support. Lecturer Svend Juul, MD, Department of Epidemiology, University of Aarhus, provided technical advice on computer programming. I am grateful for their contributions.
The Viborg County Research Foundation for Social and Health Issues, The Health Administration of Viborg County, Hans and Nora Buchard’s Foundation, and The Foundation of Alfred Helsted, chief physician and DMSc, and Eli Moller, DMSc supported the study financially.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Giversen, I.M. Time trends of mortality after first hip fractures. Osteoporos Int 18, 721–732 (2007). https://doi.org/10.1007/s00198-006-0300-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-006-0300-1