Salehi Omran Setareh, Murthy Santosh B, Navi Babak B, Merkler Alexander E
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Neurohospitalist. 2020 Apr;10(2):95-99. doi: 10.1177/1941874419859755. Epub 2019 Jun 30.
Data are lacking on the long-term risk of hip fracture among patients with ischemic stroke. A better understanding of the contemporary incidence of hip fracture after ischemic stroke could benefit patient care by promoting strategies to prevent this disabling complication in stroke survivors.
We performed a retrospective cohort study using inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included patients ≥66 years of age who were hospitalized with acute ischemic stroke, defined through a validated diagnostic code algorithm. We excluded patients who had a prior or concurrent hip fracture diagnosis at the time of ischemic stroke. The primary outcome was hip fracture requiring hospitalization. Survival statistics were used to calculate crude incidence rates, and the Kaplan-Meier method was used to calculate cumulative rates.
Among the 1 772 550 beneficiaries in our sample, 60 099 were diagnosed with an acute ischemic stroke without prior or concomitant hip fracture. During 4.5 (±2.2) years of follow-up, the incidence of hip fracture was 1.6 (95% confidence interval [CI]: 1.5-1.6) per 100 person-years in patients with acute ischemic stroke versus 0.6 (95% CI: 0.6-0.6) per 100 person-years in patients without acute ischemic stroke. The cumulative 5-year rate of hip fracture was 7.6% (95% CI: 7.2%-8.0%) among patients with acute ischemic stroke versus 2.8% (95% CI: 2.8%-2.9%) among the remaining Medicare beneficiaries.
We found that among elderly Medicare beneficiaries with acute ischemic stroke, nearly 1 in 12 developed a hip fracture over the next 5 years.
缺血性中风患者髋部骨折的长期风险数据尚缺。更好地了解缺血性中风后髋部骨折的当代发病率，可通过推广预防中风幸存者这一致残性并发症的策略，从而改善患者护理。
我们进行了一项回顾性队列研究，使用了2008年至2015年全国代表性的5%医疗保险受益人的住院和门诊理赔数据。我们纳入了年龄≥66岁、因急性缺血性中风住院的患者，通过经过验证的诊断编码算法进行定义。我们排除了在缺血性中风时已有或并发髋部骨折诊断的患者。主要结局是需要住院治疗的髋部骨折。生存统计用于计算粗发病率，Kaplan-Meier方法用于计算累积发病率。
在我们样本中的1772550名受益人中，60099人被诊断为急性缺血性中风，且无既往或同时存在的髋部骨折。在4.5（±2.2）年的随访期间，急性缺血性中风患者髋部骨折的发病率为每100人年1.6（95%置信区间[CI]：1.5 - 1.6），而无急性缺血性中风患者为每100人年0.6（95%CI：0.6 - 0.6）。急性缺血性中风患者髋部骨折的累积5年发病率为7.6%（95%CI：7.2% - 8.0%），而其余医疗保险受益人为2.8%（95%CI：2.8% - 2.9%）。
我们发现，在患有急性缺血性中风的老年医疗保险受益人中，近十二分之一的人在接下来的5年中发生了髋部骨折。
