Has Mortality After a Hip Fracture Increased?

Peter Vestergaard, MD, PhD, DrMedSc; Lars Rejnmark, MD, PhD; Leif Mosekilde, MD, DrMedSc

Disclosures

J Am Geriatr Soc. 2007;55(11):1720-1726. 

In This Article

Abstract and Introduction

Objectives: To study changes in mortality and causes of death in patients suffering a hip fracture between 1981 and 2001.
Design: Historic, register-based cohort study.
Setting: Nationwide cohort study in Denmark.
Participants: All 163,313 patients suffering a hip fracture between 1981 and 2001 in Denmark and 505,960 age- and sex-matched controls.
Interventions: Osteosynthesis, arthroplasty, or other management for the hip fracture.
Measurements: Mortality and cause of death at 30 days and 1 year.
Results: The mean age of the patients with hip fracture increased (from 75.8 in 1981 to 78.1 in 2001, P< .01), and the proportion of men with hip fracture also increased (from 25.5% to 29.8%, P< .01). A statistically significant decrease was observed in crude 1-year survival. Mortality increased in subjects with a hip fracture from 1981/85 to 1986/2001, whereas it decreased among controls. There was significantly greater mortality in patients undergoing arthroplasty (relative risk=1.05, 95% confidence interval=1.03-1.07) than in those undergoing osteosynthesis. Causes of death related to the trauma that caused the fracture explained most of the deaths (68-76%) within the first 30 days after the fracture.
Conclusion: Significant demographic changes took place, with older people and more men experiencing hip fracture. After adjustment for age, sex, and comorbidity, survival was poorer in patients suffering a hip fracture than in controls. This calls for measures to improve survival.

Hip fractures are associated with greater mortality than in the general population.[1] Because of the excess mortality in patients with hip fracture[1] and the high incidence of hip fractures in elderly subjects,[2] hip fractures may contribute to a relatively large proportion of deaths in the population. Any change in mortality after a hip fracture may thus have a significant effect on a population level.

Two American studies showed longer short-term survival after a hip fracture in a later cohort than in earlier cohorts.[3,4] However, neither used recent data; one studied compared 1965 with 1993,[3] and the other compared 1982 to 1986 with 1946 to 1955.[4] A more-recent Norwegian study showed an improvement in survival for female but not male patients with hip fracture between 1980 and 1994.[5] A small-scale study from Finland[6] covering 1982/83 to 1992/93 showed almost unchanged first-year survival, although significant changes in management took place, with more patients being treated surgically rather than conservatively and a larger percentage of patients receiving a hemiprosthesis. With the significant changes in management of patients with hip fracture, more-recent data are necessary to analyze factors of importance for survival. The only recent analysis showing improvements in mortality after hip fractures is a single center study in the United States[7] showing a decrease in mortality from 4.9% in 2000 to 0.8% in 2003 after implementation of a systematic preoperative assessment program. A large-scale epidemiological study from Great Britain[8] covering 1968 to 1993 showed a decline in case fatality rates from 1968 to approximately 1980 but no decline from approximately 1980 to 1993. None of the studies mentioned addressed causes of death or comorbidity. In the Western world, improvements in general survival have been observed.[9] The increasing mean age of the population in most Western countries may mean that crude survival of hip fracture cases would decrease, whereas age-adjusted survival might improve.

The objective of this study, therefore, was to compare crude and adjusted survival in recent years in a large cohort of patients with hip fracture with that of a control group from the general population and changes in cause of death with time in patients with hip fracture and controls.

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