Original Article

Trends in Hip Fracture-Related Mortality in Texas, 1990-2007

Authors: Carlos H. Orces, MD, MPH, Abul H. Alamgir, PhD

Abstract

Background: There are limited data about trends in hip fracture-related mortality. In this study, we examined temporal trends in hip fracture mortality rates among persons aged 50 years or older in Texas between 1990 and 2007.


Materials and Methods: Hip fracture-related mortality was defined as a death on the multiple cause of death record for which hip fracture was listed as a contributing cause. Population estimates for Texas were used as the denominator to calculate mortality rates per 100,000 persons. The joinpoint regression analysis was used to identify points where a statistically significant change occurred in the linear slope of the rates.


Results: A total of 14,350 death certificates listed hip fracture as a contributing cause of death. Hip fracture rates decreased predominantly among men by 0.8% (95% CI, −1.5 to −0.1) per year. Conversely, age-adjusted rates among women increased by 0.3% (95% CI, −0.4 to 1.0) per year. By race/ethnicity, hip fracture mortality rates increased annually 2.2% (95% CI, −0.1 to 4.4) among blacks, whereas the rates among whites and Hispanics remained steady. Moreover, the proportion of death records that listed nursing homes and residence as a place of death increased by 2.2% (95% CI, 1.6 to 2.9) and 8.7% (95% CI, 6.3 to 11.0) per year, respectively.


Conclusion: Hip fracture mortality rates decreased predominantly among men in Texas during the study period. Increasing hip fracture mortality rates among blacks and nursing home residents merit further research.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Lyles KW, Colón-Emeric CS, Magaziner JS, et al. Zoledronic acid in reducing clinical fracture and mortality after hip fracture. N Engl J Med 2007;357:1799-1809.
 
2. Tosteson AN, Gottieb DJ, Radley DC, et al. Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 2007;18:1463-1472.
 
3. Haentjens P, Magaziner J, Colon-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-390.
 
4. Abrahamsen B, van Staa T, Ariely R, et al. Excess mortality following hip fractures: a systematic epidemiological review. Osteoporos Int 2009;20:1633-1650.
 
5. Giversen IM. Time trends of mortality after first hip fractures. Osteoporos Int 2007;18:721-732.
 
6. Vestergaard P, Rejnmark L, Mosekilde L. Has mortality after hip fracture increased? J Am Geriatr Soc 2007;55:1720-1726.
 
7. Roberts SE, Goldacre MJ. Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98: database study. BMJ 2003;327:771-775.
 
8. Brauer CA, Coca-Perraillon M, Cutler DM, et al. Incidence and mortality of hip fractures in the United States. JAMA 2009;302:1573-1579.
 
9. Orces CH, Lee S, Bradshaw B. Sex and ethnic differences in hip fracture-related mortality in Texas, 1990 through 1998. Tex Med 2002;98:56-58.
     
12. World Health Organization. 2007. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Available at: http://www.who.int/classifications/apps/icd/icd10online/. Accessed October 2, 2010.
 
13. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003;163:1711-1717.
 
14. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Bridged-Race Population Estimates, United States July 1st resident population by state, county, age, sex, bridged-race, and Hispanic origin, compiled from 1990-1999 bridged-race intercensal population estimates and 2000-2007 (Vintage 2007) bridged-race postcensal population estimates, on CDC WONDER On-line Database. Available at: http://wonder.cdc.gov/bridged-race-v2007.html. Accessed July 7, 2010.
 
15. Available at: http://surveillance.cancer.gov/joinpoint/. Accessed July 7, 2010.
 
16. Kim H-J, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335-351.
 
17. Ziade N, Jougla E, Coste J. Population-level impact of osteoporotic fractures on mortality and trends over time: a nationwide analysis of vital statistics for France, 1968-2004. Am J Epidemiol 2010;172:942-951.
 
18. Wehren LE, Hawkes WG, Orwig DL, et al. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res 2003;18:2231-2237.
 
19. Kannegaard PN, Van Der Mark S, Eiken P, et al. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 2010;39:203-209.
 
20. Piirtola M, Vahlberg T, Löppönen M, et al. Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow-up. Eur J Epidemiol 2008;23:747-755.
 
21. Endo Y, Aharonoff GB, Zuckerman JD, et al. Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 2005;19:29-35.
 
22. Boereboom FT, Raymakers JA, Duursma SA. Mortality and causes of death after hip fractures in the Netherlands. Neth J Med 1992;41:4-10.
 
23. Nettleman MD, Alsip J, Schrader M, et al. Predictors of mortality after acute hip fracture. J Gen Intern Med 1996;11:765-767.
 
24. Perez JV, Warwick DJ, Case CP, et al. Death after proximal femoral fracture-an autopsy study.  Injury 1995;26:237-240.
 
25. Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005;331:1374-1376.
 
26. Dobbs RE, Parvizi J, Lewallen DG. Perioperative morbidity and 30-day mortality after intertrochanteric hip fracture treated by internal fixation or arthroplasty. J Arthroplasty 2005;20:963-966.
 
27. Vidal EI, Coeli CM, Pinheiro RS, et al. 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 2006;17:1569-1576.
 
28. Lawrence VA, Hilsenbeck SG, Noveck H, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med 2002;162:2053-2057.
 
29. de Luise C, Brimacombe M, Pedersen L, et al. Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study. Eur J Epidemiol 2008;23:115-122.
 
30. Jacobsen SJ, Goldberg J, Miles TP, et al. Race and sex differences in mortality following fracture of the hip. Am J Public Health 1992;82:1147-1150.
 
31. Lu-Yao GL, Baron JA, Barrett JA, et al. Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health 1994;84:1287-1291.
 
32. Neuman MD, Fleisher LA, Even-Shoshan O, et al. Nonoperative care for hip fracture in the elderly: the influence of race, income, and comorbidities. Med Care 2010;48:314-320.
 
33. Wu TY, Jen MH, Bottle A, et al. Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study. J Public Health (Oxf) 2010 October 5 [Epub ahead of print].
 
34. Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study.BMJ 2006;332:947-951.
 
35. Leibson CL, Tosteson AN, Gabriel SE, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 2002;50:1644-1650.
 
36. Orces CH. Trends in hospitalization for fall-related injury among older adults in the United States,1988-2005. Ageing Research 2010;1:e1.http://www.pagepress.org/journals/index.php/ar/article/view/ar.2010.e1/1540. Accessed December 12, 2010.
 
37. Donaldson LJ, Parsons L, Cook AJ. Death certification in fractured neck of femur. Public Health 1989;103:237-243.