Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2017 | Research article

The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study

Authors: Mikk Jürisson, Mait Raag, Riina Kallikorm, Margus Lember, Anneli Uusküla

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Abstract

Background

Estimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia.

Methods

Retrospective, population-based 10-year study of persons aged ≥50 in two cohorts: with hip fracture and an age- and sex-matched (in a 1:4 ratio) random sample from the national health insurance fund database for comparison. Cumulative risks, excess risks and relative risks of death were estimated using Poisson regression with 95% bootstrap confidence intervals (CI). Risks were adjusted for age and Charlson comorbidity index.

Results

We identified 8298 (2383 men, 5915 women) incident hip fracture patients from 2005 to 2013 and 33,191 (9531 men, 23,660 women) individuals for the reference group. 5552 (1564 men, 3988 women) cases and 14,037 (3514 men, 10,523 women) reference individuals died during the 10-year follow-up period. Among hip fracture patients we observed a pronounced and durable excess risk of death that was highest within 3–6 months after fracture and persisted for the full 10-year follow-up period. After adjustment for age and Charlson index, hip fracture was associated with a 21.1% (95% CI 20.0–22.5%) 10-year cumulative excess risk of death (RR 1.37, 95% CI 1.35–1.40). We found a high immediate excess risk of death in older age groups (≥80 years) and gradually accumulating excess risk in younger age groups (50–79 years). The excess risk was more pronounced among men than women.

Conclusions

By the end of the 10-year follow-up, 1 in 4 deaths in the hip fracture group was attributable to the hip fracture. The results indicate a high attributable impact of hip fracture as an independent risk factor for death.

Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009;20:1633–50. doi:10.1007/s00198-009-0920-3.CrossRefPubMed

Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, et al. Mortality after osteoporotic fractures. Osteoporos Int. 2004;15:38–42. doi:10.1007/s00198-003-1490-4.CrossRefPubMed

Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136. doi:10.1007/s11657-013-0136-1.CrossRefPubMedPubMedCentral

Kanis JA, Hiligsmann M. The application of health technology assessment in osteoporosis. Best Pract Res Clin Endocrinol Metab. 2014;28:895–910. doi:10.1016/j.beem.2014.04.001.CrossRefPubMed

Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–90. doi:10.1059/0003-4819-152-6-201003160-00008.Meta-analysis.CrossRefPubMedPubMedCentral

Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int. 2007;18:1583–93. doi:10.1007/s00198-007-0403-3.CrossRefPubMed

Tosteson ANA, Gottlieb DJ, Radley DC, Fisher ES, Melton LJ. Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int. 2007;18:1463–72. doi:10.1007/s00198-007-0429-6.CrossRefPubMedPubMedCentral

Forsen L, Søgaard AJA, Meyer HE, Forsén L, Edna T-H, Kopjar B. Survival after hip fracture: short-and long-term excess mortality according to age and gender. Osteoporos Int. 1999;10:73–8. doi:10.1007/s001980050197.CrossRefPubMed

Michaëlsson K, Nordström P, Nordström A, Garmo H, Byberg L, Pedersen NL, et al. Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins. J Bone Miner Res. 2014;29:424–31. doi:10.1002/jbmr.2029.CrossRefPubMed

10.

Kurtinaitis J, Dadonienė J, Kvederas G, Porvaneckas N, Butėnas T. Mortality after femoral neck fractures: a two-year follow-up. Medicina (Kaunas). 2012;48:145–9. http://www.ncbi.nlm.nih.gov/pubmed/22588346. Accessed 6 Mar 2015

11.

Sebestyén A, Boncz I, Sándor J, Nyárády J. Effect of surgical delay on early mortality in patients with femoral neck fracture. Int Orthop. 2008;32:375–9. doi:10.1007/s00264-007-0331-z.CrossRefPubMed

12.

Wilk R, Skrzypek M, Kowalska M, Kusz D, Wielgórecki A, Horyniecki M, et al. Standardized incidence and trend of osteoporotic hip fracture in Polish women and men: a nine year observation. Maturitas. 2013;77:59–63. doi:10.1016/j.maturitas.2013.09.004.CrossRefPubMed

13.

Icks A, Arend W, Becker C, Rapp K, Jungbluth P, Haastert B. Incidence of hip fractures in Germany, 1995-2010. Arch Osteoporos. 2013;8:140. doi:10.1007/s11657-013-0140-5.CrossRefPubMed

14.

Jürisson M, Vorobjov S, Kallikorm R, Lember M, Uusküla A. The incidence of hip fractures in Estonia, 2005-2012. Osteoporos Int. 2015;26:77–84. doi:10.1007/s00198-014-2820-4.CrossRefPubMed

15.

Eurostat. Eurostat. 2011. http://ec.europa.eu/eurostat/web/population-demography-migration-projections/population-data/database. Accessed 24 Jan 2017.

16.

Statistics Estonia/Statistikaamet. http://www.stat.ee/database. Accessed 15 Oct 2016.

17.

Estonian Health Insurance Fund - Eesti Haigekassa. https://www.haigekassa.ee/en/annual-reports. Accessed 29 Apr 2016.

18.

Lix L, Azimaee M, Osman B. Osteoporosis-related fracture case definitions for population-based administrative data. BMC Public Health. 2012;12:301. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-301. Accessed 5 Feb 2014

19.

Charlson ME, Pompei P, Ales KL, MacKenzie CR, Medical C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. doi:10.1016/0021-9681(87)90171-8.CrossRefPubMed

20.

Quan H, Sundararajan V, Halfon P, Fong A. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–9. https://www.ncbi.nlm.nih.gov/pubmed/16224307. Accessed 4 Jul 2014

21.

Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82. doi:10.1093/aje/kwq433.CrossRefPubMed

22.

Toson B, Harvey LA, Close JCT. The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture. J Clin Epidemiol. 2015;68:44–51. doi:10.1016/j.jclinepi.2014.09.017.CrossRefPubMed

23.

Radley DC, Gottlieb DJ, Fisher ES, Tosteson ANA. Comorbidity risk-adjustment strategies are comparable among persons with hip fracture. J Clin Epidemiol. 2008;61:580–7. doi:10.1016/j.jclinepi.2007.08.001.CrossRefPubMedPubMedCentral

24.

Sjölander A, Greenland S. Ignoring the matching variables in cohort studies - When is it valid and why? Stat med. 2013;32:4696–708. doi:10.1002/sim.5879.CrossRefPubMed

25.

R Core Team. R: the R project for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2015. https://www.r-project.org/. Accessed 22 Mar 2016.

26.

Carstensen B, Plummer M, Laara E, Hills M. Epi: a package for statistical analysis in epidemiology. R package version 2.7. 2016. http://cran.r-project.org/package=Epi. Accessed 9 Mar 2017.

27.

Dowle M, Srinivasan A, Gorecki J, Short T, Lianoglou S, Antonyan E. data.table: extension of data.frame. R package version 1.9.8. 2016. https://cran.r-project.org/package=data.table. Accessed 9 Mar 2017.

28.

Wickham H, Francois R. A grammar of data manipulation. R package dplyr version 0.5.0. 2016. https://cran.r-project.org/package=dplyr. Accessed 9 Mar 2017.

29.

Canty A, Ripley B. boot: Bootstrap R (S-Plus) functions. R package version 1.3–18. 2016. https://cran.r-project.org/web/packages/boot. Accessed 9 Mar 2017.

30.

Calaway R, RevolutionAnalytics, Weston S. Foreach: provides Foreach looping construct for R. R package version 1.4.3. 2015. https://cran.r-project.org/package=foreach. Accessed 9 Mar 2017.

31.

Calaway R, RevolutionAnalytics, Weston S, Tenenbaum D. doParallel: Foreach parallel adaptor for the “parallel” package. R package version 1.0.10. 2015. https://cran.r-project.org/package=doParallel. Accessed 9 Mar 2017.

32.

Wickham H. ggplot2: elegant graphics for data analysis: Springer; 2009. https://link.springer.com/book/10.1007%2F978-0-387-98141-3.

33.

Nordentoft M, Wahlbeck K, Hällgren J, Westman J, Ösby U, Alinaghizadeh H, et al. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One. 2013;8:e55176. doi:10.1371/journal.pone.0055176.CrossRefPubMedPubMedCentral

34.

Tancredi M, Rosengren A, Svensson A-M, Kosiborod M, Pivodic A, Gudbjörnsdottir S, et al. Excess mortality among persons with type 2 diabetes. http://www.nejm.org/doi/full/10.1056/NEJMoa1504347#t=article; 2015. doi:10.1056/NEJMOA1504347.

35.

Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39:203–9. doi:10.1093/ageing/afp221.CrossRefPubMed

36.

Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. 2003;32:468–73. doi:10.1016/S8756-3282(03)00061-9.CrossRefPubMed

37.

Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, et al. Mortality following the first hip fracture in Norwegian women and men (1999–2008). A NOREPOS study. Bone. 2014;63C:81–6. doi:10.1016/j.bone.2014.02.016.CrossRef

38.

Klop C, Welsing PMJ, Cooper C, Harvey NC, Elders PJM, Bijlsma JWJ, et al. Mortality in British hip fracture patients, 2000–2010: a population-based retrospective cohort study. Bone. 2014;66:171–7.CrossRefPubMed

39.

Klop C, van Staa TP, Cooper C, Harvey NC, de Vries F. The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location, and ethnicity. Osteoporos Int. 2017;28:161–8. doi:10.1007/s00198-016-3787-0.CrossRefPubMed

40.

Rapp K, Becker C, Lamb SE, Icks A, Klenk J. Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res. 2008;23:1825–31. doi:10.1359/jbmr.080702.CrossRefPubMed

41.

LeBlanc ES, Hillier TA, Pedula KL, Rizzo JH, Cawthon PM, Fink HA, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med. 2011;171:1831. doi:10.1001/archinternmed.2011.447.CrossRefPubMedPubMedCentral

42.

Jürisson M, Pisarev H, Kanis J, Borgström F, Svedbom A, Kallikorm R, et al. Quality of life, resource use, and costs related to hip fracture in Estonia. Osteoporos Int. 2016;27:2555–66. doi:10.1007/s00198-016-3544-4.CrossRefPubMed

43.

Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury. 2012;43:676–85. doi:10.1016/j.injury.2011.05.017.CrossRefPubMed

44.

Hindmarsh D, Loh M, Finch CF, Hayen A, Close JCT. Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people. Australas J Ageing. 2014;33:E1–7. doi:10.1111/j.1741-6612.2012.00638.x.CrossRefPubMed

45.

Luise C, Brimacombe M, Pedersen L, Sørensen HT, de Luise C. Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res. 2008;20:412–8. doi:10.1007/BF03325146.CrossRefPubMed

46.

Cenzer IS, Tang V, Boscardin WJ, Smith AK, Ritchie C, Wallhagen MI, et al. One-year mortality after hip fracture: development and validation of a prognostic index. J am Geriatr Soc. 2016;64:1863–8. doi:10.1111/jgs.14237.CrossRefPubMed

47.

Cauley JA, Cawthon PM, Peters KE, Cummings SR, Ensrud KE, Bauer DC, et al. Risk factors for hip fracture in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res. 2016;31:1810–9. doi:10.1002/jbmr.2836.CrossRefPubMed

48.

Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res. 2003;18:2231–7. doi:10.1359/jbmr.2003.18.12.2231.CrossRefPubMed

49.

Endo Y, Aharonoff G, Zuckerman J, Egol K, Koval K. Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma. 2005;19:29–35. https://www.ncbi.nlm.nih.gov/pubmed/15668581. Accessed 10 Mar 2016

50.

Holt G, Smith R, Duncan K, Hutchison JD, Gregori A. Gender differences in epidemiology and outcome after hip fracture: evidence from the Scottish hip fracture audit. J Bone Joint Surg Br. 2008;90:480–3. doi:10.1302/0301-620X.90B4.20264.CrossRefPubMed

51.

Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int. 2016;27:2727–37. doi:10.1007/s00198-016-3608-5.CrossRefPubMedPubMedCentral

52.

Neuhaus V, King J, Hageman MG, Ring DC. Charlson comorbidity indices and in-hospital deaths in patients with hip fractures. Clin Orthop Relat Res. 2013;471:1712–9. doi:10.1007/s11999-012-2705-9.CrossRefPubMed

53.

Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43:464–71.CrossRefPubMed

54.

Melton LJ, Atkinson EJ, St. Sauver JL, Achenbach SJ, Therneau TM, Rocca WA, et al. Predictors of excess mortality after fracture: a population-based cohort study. J Bone Miner Res. 2014;29:1681–90. doi:10.1002/jbmr.2193.CrossRefPubMedPubMedCentral

55.

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2010;15:721–39. doi:10.1359/jbmr.2000.15.4.721.CrossRef

56.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21. doi:10.1001/jama.2009.50.CrossRefPubMed

Title: The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study
Authors: Mikk Jürisson
Mait Raag
Riina Kallikorm
Margus Lember
Anneli Uusküla
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-017-1606-1

At a glance: The STEP trials

Springer Medicine

The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Pure exercise intolerance and ophthalmoplegia associated with the m.12,294G > A mutation in the MT-TL2 gene: a case report

Comparison of artificial graft versus autograft in anterior cruciate ligament reconstruction: a meta-analysis

Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation

Cross-cultural adaptation and psychometric analysis of the Arabic version of the oxford knee score in adult male with knee osteoarthritis

Acceptability of a digital health intervention alongside physiotherapy to support patients following anterior cruciate ligament reconstruction

Spinal epidural lipomatosis – an easily ignored secondary intraspinal disorder in spinal kyphotic deformities