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All-cause and cause-specific mortality after hip fracture among Chinese women and men

The Singapore Chinese Health Study

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Abstract

Summary

All-cause mortality risk persisted for 5 years after hip fractures in both men and women. There may be gender-specific differences in effect and duration of excess risk for cause-specific mortality after hip fracture.

Introduction

To determine all-cause and cause-specific mortality risk in the first 5 years after hip fracture in an Asian Chinese population.

Methods

The Singapore Chinese Health Study is a population-based cohort of 63,257 middle-aged and elderly Chinese men and women in Singapore recruited between 1993 and 1998. This cohort was followed up for hip fracture and death via linkage with nationwide hospital discharge database and death registry. As of 31 December 2008, we identified 1,166 hip fracture cases and matched five non-fracture cohort subjects by age and gender for each fracture case. Cox proportional hazards and competing risks regression models with hip fracture as a time-dependent covariate were used to determine all-cause and cause-specific mortality risk, respectively.

Results

Increase in all-cause mortality risk persisted till 5 years after hip fracture (adjusted hazard ratio, aHR = 1.58 [95 % CI, 1.35–1.86] for females and aHR = 1.64 [95 % CI, 1.30–2.06] for males). Men had higher mortality risk after hip fracture than women for deaths from stroke and cancer up to 1 year post-fracture but women with hip fracture had higher coronary artery mortality risk than men for 5 years post-fracture. Men had higher risk of death from pneumonia while women had increased risk of death from urinary tract infections. There was no difference in mortality risk by types of hip fracture surgery.

Conclusions

All-cause mortality risk persisted for 5 years after hip fractures in men and women. There are gender-specific differences in effect size and duration of excess mortality risk from hip fractures between specific causes of death.

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Acknowledgments

We thank Siew-Hong Low of the National University of Singapore for supervising the field work of the Singapore Chinese Health Study and Renwei Wang for the maintenance of the cohort study database. We also thank the Ministry of Health in Singapore for assistance with the identification of hip fracture cases and mortality via database linkages. Finally, we acknowledge the founding, long-standing Principal Investigator of the Singapore Chinese Health Study — Mimi C Yu. This study was supported by the National Medical Research Council, Singapore (NMRC/EDG/0011/2007) and National Institutes of Health, USA (NCI RO1 CA55069, R35 CA53890, R01 CA80205, and R01 CA144034).

Conflicts of interest

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Authors and Affiliations

  1. Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Block MD3, #03-20, 16 Medical Drive, 117597, Singapore, Singapore

    G. C.-H. Koh, B. C. Tai & W.-P. Koh

  2. Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore

    G. C.-H. Koh & B. C. Tai

  3. Epidemiology and Disease Control Division, Ministry of Health, Singapore, Singapore

    L.-W. Ang

  4. Public Health Group, Ministry of Health, Singapore, Singapore

    D. Heng

  5. Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    J.-M. Yuan

  6. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    J.-M. Yuan

  7. Duke-NUS Graduate Medical School Singapore, Singapore, Singapore

    W.-P. Koh

Authors
  1. G. C.-H. Koh
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  2. B. C. Tai
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  3. L.-W. Ang
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  4. D. Heng
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  5. J.-M. Yuan
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  6. W.-P. Koh
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Corresponding author

Correspondence to G. C.-H. Koh.

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Koh, G.CH., Tai, B.C., Ang, LW. et al. All-cause and cause-specific mortality after hip fracture among Chinese women and men. Osteoporos Int 24, 1981–1989 (2013). https://doi.org/10.1007/s00198-012-2183-7

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  • DOI: https://doi.org/10.1007/s00198-012-2183-7

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