Jürisson Mikk, Raag Mait, Kallikorm Riina, Lember Margus, Uusküla Anneli
Institute of Family Medicine and Public Health, University of Tartu, Ravila st 19, 50411, Tartu, Estonia.
Faculty of Medicine, University of Tartu, Ravila st 19, 50411, Tartu, Estonia.
Arch Osteoporos. 2017 Aug 28;12(1):76. doi: 10.1007/s11657-017-0370-z.
The impact of comorbidities on hip fracture-related excess mortality was assessed in a population-based age- and sex-matched cohort over 10 years. On average, only 1 out of 12 excess deaths over 10 years was related to pre-fracture life-threatening comorbidities. The presence of life-threatening comorbidities increased the excess risk of death after hip fracture.
This work aimed to estimate the impact of pre-fracture comorbidities on the 10-year excess risk of all-cause death after hip fracture among Estonian men and women ≥ 50 years of age.
Retrospective, population-based 10-year study of people aged ≥ 50 in two cohorts: those with a hip fracture and an age- and sex-matched random sample from the national health insurance fund for comparison.
We found that hip fracture was a strong independent risk factor for death. Upon adjustment for Charlson Comorbidities Index (CCI) score, the impact of life-threatening comorbidities on average hip fracture-related excess mortality was modest: only 8% of excess deaths over 10 years were related to comorbidities. Upon stratification by CCI groups, the excess risk of patients in CCI groups ≥ 3 and 1-2 exceeded that in the CCI 0 group over 5-7 years, indicating that in patients with life-threatening comorbidities, a hip fracture accelerates the chain of lethal events and brings deaths from other conditions forward. The impact of comorbidities was age- and time-dependent: in younger hip fracture patients, the comorbidities almost doubled the excess risk from a fracture in 10 years; in older patients, the effect was shorter and modest.
The presence of pre-fracture comorbidities increases the risk of excess death in hip fracture patients, but the comorbidity impact on aggregated excess mortality is modest.
在一个基于人群的年龄和性别匹配队列中，对共病对髋部骨折相关额外死亡率的影响进行了为期10年的评估。平均而言，10年中每12例额外死亡中只有1例与骨折前危及生命的共病有关。危及生命的共病的存在增加了髋部骨折后额外的死亡风险。
本研究旨在评估骨折前共病对爱沙尼亚年龄≥50岁的男性和女性髋部骨折后10年全因死亡额外风险的影响。
对两个队列中年龄≥50岁的人群进行基于人群的回顾性10年研究：髋部骨折患者以及从国家健康保险基金中抽取的年龄和性别匹配的随机样本作为对照。
我们发现髋部骨折是死亡的一个强有力的独立危险因素。在调整了查尔森共病指数（CCI）评分后，危及生命的共病对平均髋部骨折相关额外死亡率的影响不大：10年中只有8%的额外死亡与共病有关。按CCI组分层后，CCI组≥3和1 - 2的患者在5 - 7年中的额外风险超过了CCI 0组，这表明在患有危及生命共病的患者中，髋部骨折加速了致命事件的连锁反应，并使其他疾病导致的死亡提前。共病的影响与年龄和时间有关：在年轻的髋部骨折患者中，共病使10年内骨折导致的额外风险几乎增加了一倍；在老年患者中，这种影响持续时间较短且程度较小。
骨折前共病的存在增加了髋部骨折患者额外死亡的风险，但共病对总体额外死亡率的影响不大。
