Elsevier

Injury

Volume 36, Issue 11, November 2005, Pages 1323-1329
Injury

The increasing burden of pelvic fractures in older people, New South Wales, Australia

https://doi.org/10.1016/j.injury.2005.02.008Get rights and content

Summary

Despite their significant health burden, epidemiological information regarding pelvic fractures is scarce. In this study, we examine trends in admission for pelvic fractures to acute hospitals in New South Wales, Australia, between July 1988 and June 2000, using routinely collected hospital separations statistics. Over this period, the number of admissions for pelvic fractures among those aged 50 years and over increased by 58.4% in men and 110.8% in women. Age-specific rates of admissions per 100,000 population for pelvic fracture also rose significantly, particularly for those aged at least 75 years. The number and proportion of transport related pelvic fractures fell significantly for both men (χ2 = 23.82, d.f. = 1, p < 0.001) and women (χ2 = 49.26, d.f. = 1, p < 0.001) while those resulting from falls increased significantly over the 12-year-period. Falls are increasingly becoming the single most important cause of pelvic injuries in older people, suggesting that preventive measures aimed at reducing the risk of falls need to be pursued. Factors contributing to the rise of fall-related pelvic fractures need to be investigated to inform strategies aimed at reversing the observed increase in the number and age-specific rates of pelvic fractures in older people.

Introduction

Injury continues to be a source of considerable morbidity and mortality in older people as life expectancy has increased in most industrialised countries.24 Hip fracture is the most documented fracture sustained by older people, though there have also been reports on spine, wrist and humeral neck fractures.3, 6 Whilst less common, occurring with a frequency of between one third to one fifth of that of hip fractures,26 pelvic fractures are associated with significant pain, require long hospital stay and substantial health care resources.27 Long-term complications of pelvic fractures include genitourinary and reproductive dysfunction, non-healing fractures and chronic disability resulting in an inability to return to independent living and to long admissions to sub-acute health care and residential facilities.9, 30, 5, 21 Mortality associated with pelvic fractures in older people results from associated injuries as well as severe bleeding from the fracture site itself or the adjacent arterial structures.12, 30 Mortality rates have been reported to range from 5% to 20% at 1 year.13, 12, 18

Despite their significant burden, epidemiological information regarding pelvic fractures is scarce. The few reports which have examined the incidence of pelvic fractures demonstrated an increase in the number and age-specific rates in both males and females during the 1970s and 1980s.26, 27 In Australia, while pelvic fracture is among the five most common fractures in older people,3 no study has previously investigated trends in their incidence. In this study, we examine trends in admission for pelvic fracture to public and private acute hospitals in New South Wales, Australia between July 1988 and June 2000 using routinely collected hospital separations statistics. We also examine trends in the mechanism/etiology of injury, length of stay and transfer to other institutions following a pelvic fracture. The findings will inform the planning of future health care delivery and prevention strategies aimed at reducing the burden of this type of injury in older people.

Section snippets

Methods

Information on pelvic fracture cases was obtained from the Inpatient Statistics Collection (ISC) which covers all inpatient separations/discharges from acute hospitals in New South Wales (NSW) between July 1988 and June 2000. The ISC is a financial year collection which enumerates periods of stay in hospital that end with a discharge, transfer or death of a patient.8

Estimates of the total number of hospital admissions across NSW, for each financial year between 1 July 1988 and 30 June 1993,

Results

Over the period July 1988 to June 2000, the number of admissions to NSW acute hospitals for pelvic fractures increased by 58% in men and 111% in women (Table 2). The increase was observed for all age groups but was highest among those aged over 85 years in both men (270%) and women (245%).

In every year, most pelvic fractures were due to falls with the remainder resulting mainly from transport injuries (Fig. 1). The number and proportion of transport related pelvic fractures decreased

Discussion

This study represents the first assessment of pelvic fracture trends in older people over time in Australia. The number of pelvic fractures steadily increased during the period of study, particularly in women. The rise was even higher for those aged 85 years and over, where there was more than a four-fold increase. Similar findings were reported in a Finnish study indicating an average increase of 17% per year during the seventies and eighties.26 Such trends are likely to continue unabated for

Conclusions

The number and age-specific admission rates of pelvic fractures are on the rise in New South Wales, particularly among older age groups. Falls are increasingly becoming the single most important cause of pelvic injuries suggesting that preventive measures aimed at reducing the risk of falls, need to be pursued and strengthened. Research into the impact of various factors that contribute to falls such as human balance is warranted. Factors which contribute to pelvic fractures as a result of a

Acknowledgments

Both C. Finch and S. Lord are supported by National Health and Medical Research Council Principal Research Fellowships. S. Boufous is supported by the Injury Risk Management Research Centre, with core funding provided by the NSW Department of Health, the NSW Roads and Traffic Authority and the Motor Accidents Authority. The authors wish to thank the Centre for Epidemiology and Research at the NSW Health Department, for providing the data analysed in this study, and to Dr. Owen Williamson, an

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