King Alison B, Tosteson Anna N A, Wong John B, Solomon Daniel H, Burge Russel T, Dawson-Hughes Bess
Public Policy and Government Relations, Procter & Gamble Health Care, Norwich, New York 13815-0191, USA.
J Bone Miner Res. 2009 Apr;24(4):681-92. doi: 10.1359/jbmr.081226.
Demographic differences may produce interstate variation in the burden of osteoporosis. We estimated the burden of fragility fractures by race/ethnicity, age, sex, and service site across five diverse and populous states. State inpatient databases for 2000 were used to describe hospital fracture admissions, and a Markov decision model was used to estimate annual fracture incidence and cost for populations >or=50 yr of age for 2005-2025 in Arizona (AZ), California (CA), Florida (FL), Massachusetts (MA), and New York (NY). In 2000, mean hospital charges for incident fractures varied 1.7-fold across states. For hip fracture, mean charges ranged from $16,700 (MA) to $29,500 (CA), length of stay from 5.3 (AZ) to 8.9 days (NY), and discharge rate to long-term care from 43% (NY) to 71% (CA). In 2005, projected fracture incidence rates ranged from 199 (CA) to 266 (MA) per 10,000. Total cost ranged from $270 million (AZ) to $1,434 million (CA). Men accounted for 26-30% of costs. Across states, hip fractures constituted on average 77% of costs; "other" fractures (e.g., leg, arm), 10%; pelvic, 6%; vertebral, 5%; and wrist, 2%. By 2025, Hispanics are projected to represent 20% of fractures in AZ and CA and Asian/Other populations to represent 27% of fractures in NY. In conclusion, state initiatives to prevent fractures should include nonwhite populations and men, as well as white women, and should address fractures at all skeletal sites. Interstate variation in service utilization merits further evaluation to determine efficient and effective disease management strategies.
人口统计学差异可能导致骨质疏松症负担在州与州之间存在差异。我们按种族/民族、年龄、性别和服务地点，对五个不同且人口众多的州的脆性骨折负担进行了估算。利用2000年的州住院数据库来描述医院骨折入院情况，并采用马尔可夫决策模型来估算2005 - 2025年亚利桑那州（AZ）、加利福尼亚州（CA）、佛罗里达州（FL）、马萨诸塞州（MA）和纽约州（NY）50岁及以上人群的年度骨折发病率和费用。2000年，各州因新发骨折产生的平均医院费用相差1.7倍。对于髋部骨折，平均费用从16,700美元（马萨诸塞州）到29,500美元（加利福尼亚州）不等，住院时长从5.3天（亚利桑那州）到8.9天（纽约州）不等，转至长期护理机构的出院率从43%（纽约州）到71%（加利福尼亚州）不等。2005年，预计骨折发病率从每10,000人中有199例（加利福尼亚州）到266例（马萨诸塞州）不等。总费用从2.7亿美元（亚利桑那州）到14.34亿美元（加利福尼亚州）不等。男性占费用的26% - 30%。在各州，髋部骨折平均占费用的77%；“其他”骨折（如腿部、手臂）占10%；骨盆骨折占6%；脊椎骨折占5%；腕部骨折占2%。到2025年，预计西班牙裔将占亚利桑那州和加利福尼亚州骨折病例的20%，亚裔/其他人群将占纽约州骨折病例的27%。总之，各州预防骨折的举措应包括非白人人群、男性以及白人女性，并应关注所有骨骼部位的骨折。服务利用方面的州际差异值得进一步评估，以确定高效且有效的疾病管理策略。
