Thorpe Lilian U, Whiting Susan J, Li Wenbin, Dust William, Hadjistavropoulos Thomas, Teare Gary
Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
Can Geriatr J. 2017 Sep 28;20(3):97-104. doi: 10.5770/cgj.20.273. eCollection 2017 Sep.
Hip fractures (HFs) represent an important cause of morbidity and mortality among adults in long-term care (LTC), but lack of detailed epidemiological data poses challenges to intervention planning. We aimed to determine the incidence of HFs among permanent LTC residents in Saskatchewan between 2008 and 2012, using linked, provincial administrative health databases, exploring associations between outcomes and basic individual and institutional characteristics.
We utilized the Ministry of Health databases to select HF cases based on ICD 10 diagnoses fracture of head and neck of femur, pertrochanteric fracture and subtrochanteric fracture of femur. HF incidence rates in LTC were compared to older adults in the general population.
LTC residents were more likely to be female overall (65.5%), although this varied by age, with only 46.6% female in those under 65, but 77% female among those 90 years and older. Mean age of residents was highest in rural centres (85.2 yrs) and lowest in medium-large centres (81.0 yrs). Of 6,230 cases of HFs in the province during the study period, 2,743 (44%) were in the LTC cohort. Incidence rates per 1,000 person years increased with age and were higher in the LTC group (F = 68.6, M = 49.8) than the overall population (F = 1.62, M = 0.73). Rates of HFs in the province and in LTC were higher in females than males in all age groups, except for the youngest (< 65 years), where males had higher rates, and the oldest category (90+) where rates were similar. Women 90+ years in larger LTC had significantly higher ( = .035) HF rates than those in smaller LTC, and also had significantly ( = .001) higher rates in medium-large compared to smaller population centres. However, after age standardization to the overall SK population, it was apparent that the larger LTC facilities and the medium-large population centres had overall lower HF rates than the small and medium LTC facilities and the small urban and rural PCs, respectively. One health region had particularly high rates, even when accounting for age and sex composition.
Both HF numbers and incidence rates were higher in LTC compared to the overall population, with higher rates in older women, small to medium size LTC, and particular health regions. Our data suggest the need for further exploration of potentially remediable factors for HFs in smaller LTCs, and for targeting specific facilities and regions with outlying HF rates.
髋部骨折（HFs）是长期护理（LTC）机构中成年人发病和死亡的重要原因，但缺乏详细的流行病学数据给干预计划带来了挑战。我们旨在利用省级行政卫生数据库的关联数据，确定2008年至2012年期间萨斯喀彻温省长期护理机构常住居民中髋部骨折的发生率，并探讨结局与基本个人及机构特征之间的关联。
我们利用卫生部数据库，根据国际疾病分类第10版（ICD 10）诊断标准，选择股骨颈骨折、转子间骨折和股骨转子下骨折的髋部骨折病例。将长期护理机构中的髋部骨折发病率与普通人群中的老年人进行比较。
长期护理机构居民总体上女性居多（65.5%），不过这随年龄有所不同，65岁以下居民中女性仅占46.6%，而90岁及以上居民中女性占77%。农村中心居民的平均年龄最高（85.2岁），大中型中心居民的平均年龄最低（81.0岁）。在研究期间该省的6230例髋部骨折病例中，2743例（44%）发生在长期护理机构队列中。每1000人年的发病率随年龄增长而增加，长期护理机构组（女性 = 68.6，男性 = 49.8）高于总体人群（女性 = 1.62，男性 = 0.73）。除最年轻组（< 65岁，男性发病率较高）和最年长组（90岁以上，发病率相似）外，该省及长期护理机构中所有年龄组女性的髋部骨折发病率均高于男性。90岁及以上居住在大型长期护理机构的女性髋部骨折发病率显著高于小型机构（P = 0.035），且在大中型人口中心的发病率也显著高于小型机构（P = 0.001）。然而，在根据萨斯喀彻温省总体人口进行年龄标准化后，很明显大型长期护理机构和大中型人口中心的总体髋部骨折发病率分别低于小型和中型长期护理机构以及小型城乡人口中心。即使考虑年龄和性别构成，有一个卫生区域的发病率特别高。
与总体人群相比，长期护理机构中的髋部骨折数量和发病率更高，老年女性、中小型长期护理机构以及特定卫生区域的发病率更高。我们的数据表明，需要进一步探索小型长期护理机构中髋部骨折可能的可补救因素，并针对髋部骨折发病率较高的特定机构和区域。
