Ireland Anthony W, Kelly Patrick J, Cumming Robert G
Department of Veterans' Affairs, 300 Elizabeth Street, Sydney 2000, Australia; School of Public Health, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia.
School of Public Health, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia.
Injury. 2015;46(6):1028-35. doi: 10.1016/j.injury.2015.03.006. Epub 2015 Mar 12.
One-year mortality after hip fracture may exceed 30% with a very large number of reported risk factors. Determinants of mortality beyond 1 year are rarely described. This study employs multiple data linkages to examine mortality rates, risk factor profiles and age-specific excess mortality at intervals from 30 days to 4 years.
Retrospective cohort study of linked administrative datasets describing hospital episodes, residential aged care (RAC) admissions and date of death for 2552 Australian veterans and war widows hospitalised for hip fracture in 2008-09. Associations between time to death and patient age, sex, pre-fracture accommodation, fracture type, treatment options, selected comorbidities and complications were tested in Cox proportional hazards models.
In a population with mean age of 86.6 years (range 54-100 years), overall death rate was 11% at 30 days, 34% at 1 year, 47% at 2 years and 67% after 4 years. For males hospitalised from RAC 1-year mortality was 72%, contrasting with 19% for females from the community. Risk of death within 1 year was increased by male sex, increasing age, pre-fracture RAC residency, transfer to intensive care and coexistent cancer, cardiac and renal failure, cerebrovascular disease and pressure ulcers. Patients selected for rehabilitation had lower mortality rates. Patterns of determinants for mortality changed over time. Above-expected age-specific mortality was sustained for 4 years except for males 90 years and older.
Pre-fracture RAC residence was the strongest determinant factor for mortality. Patients selected for rehabilitation had lower mortality rates. The profiles of explanatory variables for death altered with increasing time from the index fracture event.
髋部骨折后1年的死亡率可能超过30%，且有大量已报道的风险因素。很少有研究描述1年以上的死亡决定因素。本研究采用多数据链接来检查从30天到4年期间的死亡率、风险因素概况以及特定年龄的超额死亡率。
对2008 - 2009年因髋部骨折住院的2552名澳大利亚退伍军人和战争寡妇的行政数据集进行回顾性队列研究，这些数据集描述了医院诊疗过程、入住老年护理机构（RAC）情况及死亡日期。在Cox比例风险模型中测试死亡时间与患者年龄、性别、骨折前居住情况、骨折类型、治疗选择、选定的合并症和并发症之间的关联。
在平均年龄为86.6岁（范围54 - 100岁）的人群中，30天时的总体死亡率为11%，1年时为34%，2年时为47%，4年后为67%。从RAC住院的男性1年死亡率为72%，而社区女性为19%。男性、年龄增加、骨折前居住在RAC、转入重症监护病房以及并存癌症、心脏和肾衰竭、脑血管疾病和压疮会增加1年内的死亡风险。被选入康复治疗的患者死亡率较低。死亡决定因素的模式随时间变化。除90岁及以上男性外，特定年龄的超额死亡率持续了4年。
骨折前居住在RAC是死亡率的最强决定因素。被选入康复治疗的患者死亡率较低。随着距骨折事件时间的增加，死亡解释变量的概况发生改变。
