School of Pharmaceutical Science and Technology, Tianjin University, No. 92 Weijin Rd., Nankai District, Tianjin, 300072, China.
Tianjin Hospital, Tianjin, 300072, China.
Arch Osteoporos. 2018 Feb 27;13(1):12. doi: 10.1007/s11657-018-0429-5.
We analyzed the incidence of medical complications after osteoporotic fractures and estimated its risk factors and cost impacts. Osteoporotic fractures can result in lots of serious medical complications, which is associated with patients' baseline characteristics such as patients' disease history and significantly increased patients' direct medical costs.
The purpose of the study is to investigate the incidence and identify the risk factors of medical complications after osteoporotic fracture, and quantify patients' economic burden.
Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2009-2014). Patients aged ≥ 50 years, had ≥ 1 diagnoses of hip or vertebral fracture between 2010 and 2012, and continuously enrolled from 12 months before to 24 months after the first identified fracture were included. The incidence of medical complications was estimated within 12 months before and after fracture. Direct medical costs were measured and compared between patients with at least one medical complication and without any medical complications. Logistic regression was applied to identify risk factors for any medical complications.
Three thousand seven hundred nineteen patients were identified; 45.0% had hip fracture, and 56.2% had vertebral fracture. After osteoporotic fracture, the accumulative incidence of the most common medical complications including constipation (25.6%, RR 1.38 [1.28, 1.48]), stroke (25.2%, 1.16 [1.09, 1.24]), pneumonia (17.0%, 1.55 [1.40, 1.73]), urinary tract infection (16.3%, 1.23 [1.12, 1.36]), and arrhythmia (11.8%, 1.39 [1.23, 1.56]) was significantly higher than that before fracture. Advanced age; male sex; retirement status; diagnosis of hypertension, chronic heart disease, cerebrovascular disease, hemiplegia, or Parkinson's disease; and higher direct medical costs at baseline were significant predictors of complications. The all-cause direct medical cost during 24-month follow-up was $5665. Medical complications significantly increased patients' direct medical costs.
Osteoporotic fractures led to amount of medical complications, which significantly increased patients' economic burden. Complications correlate to various factors such as patients' disease history.
研究目的是调查骨质疏松性骨折后医疗并发症的发生率，确定其危险因素，并量化患者的经济负担。
数据来自天津市城镇职工基本医疗保险数据库（2009-2014 年）。纳入标准为年龄≥50 岁、2010 年至 2012 年至少有一次髋部或椎体骨折诊断、骨折前 12 个月至骨折后 24 个月持续参保的患者。在骨折前和后 12 个月内估计医疗并发症的发生率。测量并比较至少有一种医疗并发症和无任何医疗并发症患者的直接医疗费用。应用 logistic 回归分析识别任何医疗并发症的危险因素。
共纳入 3719 例患者，其中 45.0%为髋部骨折，56.2%为椎体骨折。骨质疏松性骨折后，最常见的医疗并发症包括便秘（25.6%，RR 1.38[1.28，1.48]）、中风（25.2%，1.16[1.09，1.24]）、肺炎（17.0%，1.55[1.40，1.73]）、尿路感染（16.3%，1.23[1.12，1.36]）和心律失常（11.8%，1.39[1.23，1.56]）的累积发生率明显高于骨折前。高龄；男性；退休状态；高血压、慢性心脏病、脑血管疾病、偏瘫或帕金森病的诊断；以及基线时较高的直接医疗费用是并发症的显著预测因素。24 个月随访期间的全因直接医疗费用为 5665 美元。医疗并发症显著增加了患者的直接医疗费用。
骨质疏松性骨折导致大量医疗并发症，显著增加了患者的经济负担。并发症与患者的病史等多种因素相关。
