Brauer Carmen A, Coca-Perraillon Marcelo, Cutler David M, Rosen Allison B
Division of Orthopedic Surgery, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8.
JAMA. 2009 Oct 14;302(14):1573-9. doi: 10.1001/jama.2009.1462.
Understanding the incidence and subsequent mortality following hip fracture is essential to measuring population health and the value of improvements in health care.
To examine trends in hip fracture incidence and resulting mortality over 20 years in the US Medicare population.
DESIGN, SETTING, AND PATIENTS: Observational study using data from a 20% sample of Medicare claims from 1985-2005. In patients 65 years or older, we identified 786,717 hip fractures for analysis. Medication data were obtained from 109,805 respondents to the Medicare Current Beneficiary Survey between 1992 and 2005.
Age- and sex-specific incidence of hip fracture and age- and risk-adjusted mortality rates.
Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100,000 (95% confidence interval [CI], 921.7-992.9) for women and 414.4 per 100,000 (95% CI, 401.6-427.3) for men. The age-adjusted incidence of hip fracture increased from 1986 to 1995 and then steadily declined from 1995 to 2005. In women, incidence increased 9.0%, from 964.2 per 100,000 (95% CI, 958.3-970.1) in 1986 to 1050.9 (95% CI, 1045.2-1056.7) in 1995, with a subsequent decline of 24.5% to 793.5 (95% CI, 788.7-798.3) in 2005. In men, the increase in incidence from 1986 to 1995 was 16.4%, from 392.4 (95% CI, 387.8-397.0) to 456.6 (95% CI, 452.0-461.3), and the subsequent decrease to 2005 was 19.2%, to 369.0 (95% CI, 365.1-372.8). Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-, 180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively. Over time, patients with hip fracture have had an increase in all comorbidities recorded except paralysis. The incidence decrease is coincident with increased use of bisphosphonates.
In the United States, hip fracture rates and subsequent mortality among persons 65 years and older are declining, and comorbidities among patients with hip fractures have increased.
了解髋部骨折后的发病率及随后的死亡率对于衡量人群健康状况以及医疗保健改善的价值至关重要。
研究美国医疗保险人群20年间髋部骨折发病率及由此导致的死亡率的趋势。
设计、设置与患者：一项观察性研究，使用1985 - 2005年医疗保险索赔20%样本的数据。在65岁及以上的患者中，我们确定了786,717例髋部骨折用于分析。用药数据来自1992年至2005年期间对医疗保险当前受益人的调查中的109,805名受访者。
按年龄和性别划分的髋部骨折发病率以及按年龄和风险调整的死亡率。
1986年至2005年期间，女性髋部骨折的年平均数量为每10万人957.3例（95%置信区间[CI]，921.7 - 992.9），男性为每10万人414.4例（95%CI，401.6 - 427.3）。经年龄调整的髋部骨折发病率在1986年至1995年期间上升，然后在1995年至2005年期间稳步下降。在女性中，发病率上升了9.0%，从1986年的每10万人964.2例（95%CI，958.3 - 970.1）升至1995年的1050.9例（95%CI，1045.2 - 1056.7），随后下降了24.5%，至2005年的793.5例（95%CI，788.7 - 798.3）。在男性中，1986年至1995年期间发病率上升了16.4%，从392.4例（95%CI，387.8 - 397.0）升至456.6例（95%CI，452.0 - 461.3），随后至2005年下降了19.2%，至369.0例（95%CI，365.1 - 372.8）。女性30天、180天和360天的年龄和风险调整死亡率分别下降了11.9%、14.9%和8.8%。男性30天、180天和360天的年龄和风险调整死亡率分别下降了21.8%、25.4%和20.0%。随着时间推移，除瘫痪外，髋部骨折患者记录的所有合并症都有所增加。发病率下降与双膦酸盐类药物使用增加同时出现。
在美国，65岁及以上人群的髋部骨折率及随后的死亡率正在下降，髋部骨折患者的合并症有所增加。
