Original Article

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

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


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.

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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.