Klop Corinne, Welsing Paco M J, Cooper Cyrus, Harvey Nicholas C, Elders Petra J M, Bijlsma Johannes W J, Leufkens Hubert G M, de Vries Frank
Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, Netherlands.
Rheumatology and Clinical Immunology, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center, 3508 GA Utrecht, Netherlands.
Bone. 2014 Sep;66:171-7. doi: 10.1016/j.bone.2014.06.011. Epub 2014 Jun 14.
Data on recent trends in mortality after hip fracture are scarce. Aims were therefore to examine secular trends in all-cause and cause-specific mortality post hip fracture and to compare this to the general population from 2000 to 2010.
Population-based cohort study within the United Kingdom Clinical Practice Research Datalink and linked to cause of death data for 57.7% of patients. Patients with a first hip fracture (n=31,495) were matched to up to four controls by age, sex, index date, and practice. All subjects were followed for death, and lifestyle, disease and medication history adjusted hazard ratios (HRs) were calculated.
One-year all-cause mortality after hip fracture declined from 2009 and was 14% lower after, compared with before 2009 (22.3% to 20.5%, adj. HR 0.86, 95% CI: 0.81-0.92). The decline was observed for males (≥75years) and females (≥85years). Significant contributors to the decline in mortality post hip fracture were respiratory infections in females as were malignant diseases in males. However, one-year all-cause mortality remained unaltered over the decade when compared to controls with a 3.5-fold and 2.4-fold increased risk in males and females respectively. No significant changes were observed in the relative risks for one-year cause-specific mortality for both genders.
One-year mortality after hip fracture has declined over the last decade in the UK. However, the difference in one-year mortality between hip fracture patients and the general population remained unaltered. These observations highlight the need for the continued implementation of evidence-based standards for good hip fracture care.
关于髋部骨折后死亡率近期趋势的数据稀缺。因此，本研究旨在探讨髋部骨折后全因死亡率和特定病因死亡率的长期趋势，并将其与2000年至2010年的普通人群进行比较。
在英国临床实践研究数据链中进行基于人群的队列研究，并与57.7%患者的死亡原因数据相链接。首次髋部骨折患者（n = 31,495）按年龄、性别、索引日期和医疗机构与多达四名对照进行匹配。对所有受试者进行死亡随访，并计算调整生活方式、疾病和用药史后的风险比（HRs）。
髋部骨折后一年全因死亡率自2009年起下降，与2009年之前相比降低了14%（从22.3%降至20.5%，调整后HR为0.86，95%CI：0.81 - 0.92）。在男性（≥75岁）和女性（≥85岁）中均观察到了这种下降。髋部骨折后死亡率下降的重要因素在女性中是呼吸道感染，在男性中是恶性疾病。然而，与对照组相比，十年间髋部骨折患者的一年全因死亡率未发生变化，男性和女性的风险分别增加了3.5倍和2.4倍。两性一年特定病因死亡率的相对风险未观察到显著变化。
在英国，过去十年中髋部骨折后一年死亡率有所下降。然而，髋部骨折患者与普通人群一年死亡率的差异仍未改变。这些观察结果凸显了持续实施基于证据的优质髋部骨折护理标准的必要性。
