Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN.
Am J Kidney Dis. 2013 Oct;62(4):747-54. doi: 10.1053/j.ajkd.2013.02.368. Epub 2013 Apr 28.
Changes in mineral and bone disorder treatment patterns and demographic changes in the dialysis population may have influenced hip fracture rates in US dialysis patients in 1993-2010.
Retrospective follow-up study analyzing trends over time in hospitalized hip fracture rates.
SETTING & PARTICIPANTS: Using Medicare data, we created 2 point-prevalent study cohorts for each study year. Hemodialysis cohorts included patients with Medicare as primary payer receiving hemodialysis in the United States on January 1 of each year; non-end-stage renal disease (ESRD) cohorts included Medicare beneficiaries 66 years or older on January 1 of each year.
Age, sex, race, primary cause of ESRD, dual Medicare/Medicaid enrollment status, comorbid conditions.
Hip fracture rates.
Unadjusted hip fracture rates measured using number of events per 1,000 person-years in each year, then adjusted for patient characteristics. Poisson models estimated strata-specific event rates.
The observed number of first hospitalized hip fracture events and the adjusted hip fracture rate increased steadily from 1993 (831 events; 11.9/1,000 person-years), peaked in 2004 (3,256 events; 21.9/1,000 person-years), and decreased through 2010 (2,912 events; 16.6/1,000 person-years). The trend for the subset of hemodialysis patients 66 years or older was similar to the trend for the full hemodialysis cohort; however, it differed markedly in magnitude and pattern from the non-ESRD Medicare cohort, for which rates were substantially lower and slowly decreasing since 1996.
Unable to provide causal explanations for observed changes; hip fractures identified through inpatient episodes; results do not describe hemodialysis patients without Medicare Parts A and B; laboratory values unavailable in the Medicare data set.
Temporal trends in hip fracture rates among Medicare hemodialysis patients differ markedly from the steadily decreasing trend in non-ESRD Medicare beneficiaries, showing a relatively rapid increase until 2004 and relatively rapid decrease thereafter. Further research is needed to define associated factors.
在 1993 年至 2010 年间，矿物质和骨骼疾病治疗模式的变化以及透析人群的人口统计学变化可能影响了美国透析患者的髋部骨折发生率。
分析随时间推移住院髋部骨折发生率趋势的回顾性随访研究。
使用医疗保险数据，我们为每个研究年份创建了两个时点流行研究队列。血液透析队列包括 1 月 1 日在美国接受血液透析且医疗保险为主要支付方的患者；非终末期肾脏疾病（ESRD）队列包括每年 1 月 1 日年满 66 岁的医疗保险受益人。
年龄、性别、种族、ESRD 的主要原因、双重医疗保险/医疗补助参保状态、合并症。
髋部骨折发生率。
每年每 1000 人年发生事件数测量未调整的髋部骨折发生率，然后根据患者特征进行调整。泊松模型估计了特定层的事件率。
1993 年（831 例事件；11.9/1000 人年）首次观察到的住院髋部骨折事件数和调整后的髋部骨折发生率稳步增加，在 2004 年达到峰值（3256 例事件；21.9/1000 人年），并在 2010 年下降（2912 例事件；16.6/1000 人年）。66 岁及以上血液透析患者亚组的趋势与全血液透析队列的趋势相似，但在幅度和模式上与非 ESRD 医疗保险队列明显不同，后者的发生率自 1996 年以来一直较低且呈缓慢下降趋势。
无法对观察到的变化提供因果解释；髋部骨折通过住院病例确定；结果不适用于没有医疗保险 A 部分和 B 部分的血液透析患者；医疗保险数据集中没有实验室值。
医疗保险血液透析患者髋部骨折发生率的时间趋势与非 ESRD 医疗保险受益人的稳步下降趋势明显不同，在 2004 年前呈相对较快的上升趋势，此后呈相对较快的下降趋势。需要进一步研究来确定相关因素。
