Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project

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Abstract

Hip fractures are associated with diminished quality of life and survival especially amongst the elderly.

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Most cited references 26

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Mortality after all major types of osteoporotic fracture in men and women: an observational study.

J. Eisman, P N Sambrook, D. Schneider … (1999)

Mortality increases after hip fractures in women and more so in men. Little is known, however, about mortality after other fractures. We investigated the mortality associated with all fracture types in elderly women and men. We did a 5-year prospective cohort study in the semi-urban city of Dubbo, Australia, of all residents aged 60 years and older (2413 women and 1898 men). Low-trauma osteoporotic fractures that occurred between 1989 and 1994, confirmed by radiography and personal interview, were classified as proximal femur, vertebral, and groupings of other major and minor fractures. We calculated standardised mortality rates from death certificates for people with fractures compared with the Dubbo population. 356 women and 137 men had low-trauma fractures. In women and men, mortality was increased in the first year after all major fractures. In women, age-standardised mortality ratios were 2.18 (95% CI 2.03-2.32) for proximal femur, 1.66 (1.51-1.80) for vertebral, 1.92 (1.70-2.14) for other major, and 0.75 (0.66-0.84) for minor fractures. In men, these ratios were 3.17 (2.90-3.44) for proximal femur, 2.38 (2.17-2.59) for vertebral, 2.22 (1.91-2.52) for other major, and 1.45 (1.25-1.65) for minor fractures. There were excess deaths (excluding minor fractures in women) in all age-groups. All major fractures were associated with increased mortality, especially in men. The loss of potential years of life in the younger age-group shows that preventative strategies for fracture should not focus on older patients at the expense of younger women and of men.

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Test for additive interaction in proportional hazards models.

Rongling Li, Lloyd Ellwood Chambless (2007)

We describe a method for testing and estimating a two-way additive interaction between two categorical variables, each of which has greater than or equal to two levels. We test additive and multiplicative interactions in the same proportional hazards model and measure additivity by relative excess risk due to interaction (RERI), proportion of disease attributable to interaction (AP), and synergy index (S). A simulation study was used to compare the performance of these measures of additivity. Data from the Atherosclerosis Risk in Communities cohort study with a total of 15,792 subjects were used to exemplify the methods. The test and measures of departure from additivity depend neither on follow-up time nor on the covariates. The simulation study indicates that RERI is the best choice of measures of additivity using a proportional hazards model. The examples indicated that an interaction between two variables can be statistically significant on additive measure (RERI=1.14, p=0.04) but not on multiplicative measure (beta3=0.59, p=0.12) and that additive and multiplicative interactions can be in opposite directions (RERI=0.08, beta3=-0.08). The method has broader application for any regression models with a rate as the dependent variable. In the case that both additive and multiplicative interactions are statistically significant and in the opposite direction, the interpretation needs caution.

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Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival.

Pia Kannegaard, Pia A. Eiken, Susanne van der Pol … (2010)

osteoporosis is a common disease, and the incidence of osteoporotic fractures is expected to rise with the growing elderly population. Immediately following, and probably several years after a hip fracture, patients, both men and women, have a higher risk of dying compared to the general population regardless of age. The aim of this study was to assess excess mortality following hip fracture and, if possible, identify reasons for the difference between mortality for the two genders. this is a nationwide register-based cohort study presenting data from the National Hospital Discharge Register on mortality, comorbidity and medication for all Danish patients (more than 41,000 persons) experiencing a hip fracture between 1 January 1999 and 31 December 2002. Follow-up period was until 31 December 2005. we found a substantially higher mortality among male hip fracture patients than female hip fracture patients despite men being 4 years younger at the time of fracture. Both male and female hip fracture patients were found to have an excess mortality rate compared to the general population. The cumulative mortality at 12 months among hip fracture patients compared to the general population was 37.1% (9.9%) in men and 26.4% (9.3%) in women. In the first year, the risk of death significantly increased for women with increasing age (hazard ratio, HR: 1.06, 95% confidence interval, CI: 1.06-1.07), the number of comedications (HR 1.04, 95% CI 1.03-1.05) and the presence of specific Charlson index components and medications described below. For men, age (HR 1.07, 95% CI 1.07-1.08), number of comedications (HR 1.06, 95% CI 1.04-1.07) and presence of different specific Charlson index components and medications increased the risk. Long-term survival analyses revealed that excess mortality for men compared with women remained strongly significant (HR 1.70, 95% CI 1.65-1.75, P < 0.001), even when controlled for age, fracture site, the number of medications, exposure to drug classes A, C, D, G, J, M, N, P, S and for chronic comorbidities. excess mortality among male patients cannot be explained by controlling for known comorbidity and medications. Besides gender, we found higher age and multimorbidity to be related to an increased risk of dying within the first year after fracture; acute complications might be one of the explanations. This study emphasises the need for particular rigorous postoperative diagnostic evaluation and treatment of comorbid conditions in the male hip fracture patient.

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Author and article information

Journal

Title: Journal of Internal Medicine

Abbreviated Title: J Intern Med

Publisher: Wiley

ISSN: 09546820

Publication date Created: March 2017

Publication date (Print): March 2017

Publication date (Electronic): January 17 2017

Volume: 281

Issue: 3

Pages: 300-310

Affiliations

[1 ]Hellenic Health Foundation; Athens Greece

[2 ]School of Medicine; Department of Hygiene, Epidemiology and Medical Statistics; National and Kapodistrian University of Athens; Athens Greece

[3 ]Channing Division of Network Medicine; Brigham and Women's Hospital; Boston MA USA

[4 ]Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden

[5 ]Faculty of Medicine; Department of Community Medicine and Rehabilitation, Geriatric Medicine; Umeå University; Umeå Sweden

[6 ]Department of Community Medicine; UIT The Arctic University of Norway; Tromsø Norway

[7 ]Department of Health and Care Sciences; UIT The Arctic University of Norway; Tromsø Norway

[8 ]Institute of Public Health; College of Medicine and Health Sciences; United Arab Emirates University; Al Ain UAE

[9 ]Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany

[10 ]Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden

[11 ]National Institute of Public Health; Prague Czech Republic

[12 ]Department of Epidemiology and Public Health; University College London; London UK

[13 ]Institute for Translational Epidemiology and Tisch Cancer Institute; Icahn School of Medicine at Mount Sinai; New York NY USA

Article

DOI: 10.1111/joim.12586

PubMed ID: 28093824

SO-VID: c30a2fa7-c45e-4021-b40c-1e0ca5552062

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Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project

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Most cited references 26

Mortality after all major types of osteoporotic fracture in men and women: an observational study.

Test for additive interaction in proportional hazards models.

Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival.

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