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Relative survival after hospitalisation for hip fracture in older people in New South Wales, Australia

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Abstract

Summary

Survival after hospitalisation for hip fracture by age group and sex relative to survival in the general population was assessed in people aged 65+. Men had double the risk of death compared with women to 1 year, but age effects lasted only to 3 months. Clinical outcomes need to be improved.

Introduction

We assessed the relative survival of hospitalised fall-related hip fracture patients aged 65+ years leaving hospital in New South Wales, Australia, between July 2000 and December 2003.

Method

We carried out a population-based study of all hospital separations for NSW residents with a principal diagnosis of hip fracture (ICD-10-AM S72.0 to S72.2) and first external cause of fall (ICD-10-AM codes W00 to W19), linked to NSW death data. A total of 16,836 cases were included. Relative survival 3 to 36 months post-admission by 10-year age groups and sex was calculated, using NSW life tables for 2002–2004. Relative excess risk was modelled using a generalised linear model with Poisson error structure, using the life table data.

Results

One-year cumulative relative survival in 65- to 74-year-olds was 82% (men), 90% (women); in 85+-year-olds 65% (men), 80% (women). Men have a relative excess risk of death of 2.2 (95% CI 2.03–2.38) times that of women. Only 21% of deaths mention the hip fracture as contributing to death.

Conclusion

There is a need to reduce the number of hip fractures and improve clinical outcomes for older people hospitalised with hip fractures.

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References

  1. 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

    Article  PubMed  Google Scholar 

  2. Boufous S, Finch CF, Lord SR (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180:623–626

    PubMed  Google Scholar 

  3. Kreisfeld R, Newson R (2006) Hip fracture injuries. In: AIHW National Injury Surveillance Unit Briefing. Flinders University, Adelaide

    Google Scholar 

  4. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ (2003) Mortality risk after hip fracture. J Orthop Trauma 17:53–56

    Article  PubMed  Google Scholar 

  5. Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374

    Article  PubMed  CAS  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  7. Todd CJ, Freeman CJ, Camilleri-Ferrante C et al (1995) Differences in mortality after fracture of hip: the East Anglian audit. BMJ 310:904–908

    PubMed  CAS  Google Scholar 

  8. Tosteson ANA, Gottlieb DJ, Radley DC, Fisher ES, Melton LJ (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18:1463–1472

    Article  PubMed  CAS  Google Scholar 

  9. Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD (1997) Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 11(3):162–165

    Article  PubMed  CAS  Google Scholar 

  10. Alegre-Lopez J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernandez-Melon J (2005) Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int 16:729–736

    Article  PubMed  Google Scholar 

  11. Eastwood EA, Magaziner J, Wang J et al (2002) Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc 50:1240–1249

    Article  PubMed  Google Scholar 

  12. Hannan EL, Magaziner J, Wang JJ et al (2001) Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 285:2736–2742

    Article  PubMed  CAS  Google Scholar 

  13. Jalovaara P, Virkkunen H (1991) Quality of life after primary hemiarthroplasty for femoral neck fracture. 6-year follow-up of 185 patients. Acta Orthop Scand 62:208–217

    Article  PubMed  CAS  Google Scholar 

  14. Kamel HK (2005) Mortality among male veterans with hip fractures. J Am Med Dir Assoc 6:169–170

    Article  PubMed  Google Scholar 

  15. Marottoli RA, Berkman LF, Cooney LM Jr (1992) Decline in physical function following hip fracture. J Am Geriatr Soc 40:861–866

    PubMed  CAS  Google Scholar 

  16. Parker MJ, Palmer CR (1995) Prediction of rehabilitation after hip fracture. Age Ageing 24:96–98

    Article  PubMed  CAS  Google Scholar 

  17. Becker C, Gebhard F, Fleischer S et al (2003) Prediction of mortality, mobility and admission to long-term care after hip fractures. Unfallchirurg 106:32–38

    Article  PubMed  CAS  Google Scholar 

  18. Bonar SK, Tinetti ME, Speechley M, Cooney LM (1990) Factors associated with short- versus long-term skilled nursing facility placement among community-living hip fracture patients. J Am Geriatr Soc 38:1139–1144

    PubMed  CAS  Google Scholar 

  19. Koike Y, Imaizumi H, Takahashi E, Matsubara Y, Komatsu H (1999) Determining factors of mortality in the elderly with hip fractures. Tohoku J Exp Med 188:139–142

    Article  PubMed  CAS  Google Scholar 

  20. Pande I, Scott DL, O’Neill TW, Pritchard C, Woolf AD, Davis MJ (2006) Quality of life, morbidity, and mortality after low trauma hip fracture in men. Ann Rheum Dis 65:87–92

    Article  PubMed  CAS  Google Scholar 

  21. Kamel HK, Bida A, Hoffmann RG (2004) Mortality among male veterans with hip fractures. Internet Journal of Geriatrics and Gerontology 1

  22. 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

    Article  PubMed  Google Scholar 

  23. Fransen M, Woodward M, Norton R, Robinson E, Butler M, Campbell AJ (2002) Excess mortality or institutionalization after hip fracture: men are at greater risk than women. J Am Geriatr Soc 50:685–690

    Article  PubMed  Google Scholar 

  24. Kirke PN, Sutton M, Burke H, Daly L (2002) Outcome of hip fracture in older Irish women: a 2-year follow-up of subjects in a case-control study. Injury 33:387–391

    Article  PubMed  CAS  Google Scholar 

  25. Maggio D, Ubaldi E, Simonelli G, Cenci S, Pedone C, Cherubini A (2001) Hip fracture in nursing homes: an Italian study on prevalence, latency, risk factors, and impact on mobility. Calcif Tissue Int 68:337–341

    Article  PubMed  CAS  Google Scholar 

  26. Nurmi IS, Luthje PM, Kataja JM (2004) Long-term survival after falls among the elderly in institutional care. Arch Gerontol Geriatr 38:1–10

    Article  PubMed  Google Scholar 

  27. Wolinsky FD, Fitzgerald JF (1994) The risk of hip fracture among noninstitutionalized older adults. J Gerontol 49:S165–S175

    PubMed  CAS  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. Davidson CW, Merrilees MJ, Wilkinson TJ, McKie JS, Gilchrist NL (2001) Hip fracture mortality and morbidity—can we do better? N Z Med J 114:329–332

    PubMed  CAS  Google Scholar 

  30. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50:1644–1650

    Article  PubMed  Google Scholar 

  31. Melton LJ III, 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

    Article  PubMed  Google Scholar 

  32. Goldacre MJ, Roberts SE, Yeates D (2002) Mortality after admission to hospital with fractured neck of femur: database study. BMJ 325:868–869

    Article  PubMed  Google Scholar 

  33. Bass E, Campbell RR, Werner DC, Nelson A, Bulat T (2004) Inpatient mortality of hip fracture patients in the Veterans Health Administration. Rehabil Nurs 29:215–220

    PubMed  Google Scholar 

  34. Brophy S, John G, Evans E, Lyons RA (2006) Methodological issues in the identification of hip fractures using routine hospital data: a database study. Osteoporos Int 17:405–409

    Article  PubMed  Google Scholar 

  35. Vidal EI, Coeli CM, Pinheiro RS, Camargo KR Jr (2006) 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

    Article  PubMed  CAS  Google Scholar 

  36. Calder SJ, Anderson GH, Gregg PJ (1996) Certification of cause of death in patients dying soon after proximal femoral fracture. BMJ 312:1515

    PubMed  CAS  Google Scholar 

  37. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278

    Article  PubMed  CAS  Google Scholar 

  38. Hosmer ADW, Lemeshow S (1999) Applied survival analysis: regression modeling of time to event data. Wiley, New York

    Google Scholar 

  39. Dickman PW (2007) Estimating and modelling relative survival in SAS and Stata. http://www.pauldickman.com/rsmodel/index.php. Accessed 17 October 2007

  40. ABS (2005) Life tables, New South Wales, 2004. http://abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3302.1.55.0012004?OpenDocument. Accessed 17 October 2007

  41. Dickman PW, Sloggett A, Hills M, Hakulinen T (2004) Regression models for relative survival. Stat Med 23:51–64

    Article  PubMed  Google Scholar 

  42. Evans JG (2000) The epidemiology of proximal femoral fracture. In: Evans JG, Williams FT, Beattie BL, Michel J-P, Wilcock G (eds) Oxford textbook of geriatric medicine, 2nd edn. Oxford University Press, New York

    Google Scholar 

  43. Australian Bureau of Statistics (2007) Migration, Australia, 2005–06. ABS cat. no. 3412.0. Australian Bureau of Statistics, Canberra

  44. Cameron CM, Purdie DM, Kliewer EV, McClure RJ (2005) Long-term mortality following trauma: 10 year follow-up in a population-based sample of injured adults. J Trauma 59:639–646

    Article  PubMed  CAS  Google Scholar 

  45. Bottle A, Aylin P (2006) Mortality associated with delay in operation after hip fracture: observational study. BMJ 332:947–951

    Article  PubMed  Google Scholar 

  46. Foss NB, Kehlet H (2005) Mortality analysis in hip fracture patients: implications for design of future outcome trials. Br J Anaesth 94:24–29

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

DH was supported by the NSW Biostatistical Officer Training Program. Her work on this project was carried out while working at the NSW Injury Risk Management Research Centre, with funding from the Centre for Health Advancement, NSW Health. AH was supported by the NSW Injury Risk Management Research Centre (IRMRC), with core funding provided by the NSW Health Department, the NSW Roads and Traffic Authority and the Motor Accident Authority. CF was supported by a National Health and Medical Research Council (NHMRC) Principal Research Fellowship. The authors wish to thank the Centre for Epidemiology and Research at the NSW Health Department for providing the data from the Health Outcomes and Information Statistical Toolkit (HOIST) analysed in this study.

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Correspondence to D. M. Hindmarsh.

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Hindmarsh, D.M., Hayen, A., Finch, C.F. et al. Relative survival after hospitalisation for hip fracture in older people in New South Wales, Australia. Osteoporos Int 20, 221–229 (2009). https://doi.org/10.1007/s00198-008-0641-z

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  • DOI: https://doi.org/10.1007/s00198-008-0641-z

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