Bass Elizabeth, French Dustin D, Bradham Douglas D, Rubenstein Laurence Z
VISN-8 Patient Safety Center of Inquiry, James A. Haley Veterans Affairs Medical Center, Tampa, FL 33612, USA.
Ann Epidemiol. 2007 Jul;17(7):514-9. doi: 10.1016/j.annepidem.2006.12.004. Epub 2007 Apr 8.
The goal of this research was to estimate 12-month survival rates for a large sample of elderly veterans after hip fracture with a risk-adjusted model and to compare the results of men to those of women.
The study design was a retrospective, secondary data analysis of national Veterans Health Administration (VHA) Medicare beneficiaries. The study population was 43,165 veterans with hip fracture first admitted to a Medicare-eligible facility during our specified enrollment period of 1999-2002. Measurement was a Cox proportional hazard model or survival analysis of hip fracture patients with an outcome of death over a 1 year period after discharge controlled by age, gender, and selected Elixhauser comorbidities.
The unadjusted, 1 year mortality rates (30 days = 9.7%, 90 days = 17.5%, 180 days = 24%, 365 days = 32.2%) were slightly higher than the adjusted rates (30 days = 8.9%, 90 days = 15.6%, 180 days = 21.8%, 1 year = 29.9%). The mortality odds for women 12 months after hip fracture were 18%, compared with 32% for men. The comorbidity adjustment suggested that the presence of metastatic cancer increased the risk of death by almost 4 times compared with those patients without this diagnosis. Other particularly high-risk conditions included congestive heart failure, renal failure, liver disease, lymphoma, and weight loss, each of which increased the 1 year mortality risk by approximately two-fold.
One in 3 elderly male veterans who sustain a hip fracture dies within 1 year. Our work represents the first large study of hip fractures with a predominantly male sample and confirms that men have a higher mortality risk than women, as reported by previous researchers who used smaller samples that were mostly female. Fracture patients with metastatic cancer, renal failure, lymphoma, weight loss, and liver disease have higher mortality risks. The adverse outcomes associated with hip fracture argue for clinical intervention strategies, such as gait and balance testing, and osteoporosis diagnosis that may prevent fractures in both genders.
本研究的目的是使用风险调整模型估计大量老年退伍军人髋部骨折后的12个月生存率，并比较男性和女性的结果。
研究设计为对国家退伍军人健康管理局（VHA）医疗保险受益人的回顾性二次数据分析。研究人群为43165名髋部骨折退伍军人，他们在我们指定的1999 - 2002年入组期间首次入住符合医疗保险条件的机构。测量方法是对髋部骨折患者进行Cox比例风险模型或生存分析，以出院后1年的死亡结果为观察指标，并根据年龄、性别和选定的埃利克斯豪泽合并症进行控制。
未调整的1年死亡率（30天 = 9.7%，90天 = 17.5%，180天 = 24%，365天 = 32.2%）略高于调整后的死亡率（30天 = 8.9%，90天 = 15.6%，180天 = 21.8%，1年 = 29.9%）。髋部骨折后12个月女性的死亡几率为18%，男性为32%。合并症调整表明，与未诊断出转移性癌症的患者相比，患有转移性癌症会使死亡风险增加近4倍。其他特别高危的情况包括充血性心力衰竭、肾衰竭、肝病、淋巴瘤和体重减轻，每一种情况都会使1年死亡风险增加约两倍。
每3名髋部骨折的老年男性退伍军人中就有1人在1年内死亡。我们的研究是第一项以男性样本为主的关于髋部骨折的大型研究，证实了男性的死亡风险高于女性，正如之前使用大多为女性的较小样本的研究人员所报告的那样。患有转移性癌症、肾衰竭、淋巴瘤、体重减轻和肝病的骨折患者死亡风险更高。与髋部骨折相关的不良后果表明需要采取临床干预策略，如步态和平衡测试以及骨质疏松症诊断，这可能预防两性的骨折。
