Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
J Bone Miner Res. 2021 Mar;36(3):480-488. doi: 10.1002/jbmr.4212. Epub 2021 Jan 6.
Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29-1.44; HR women = 1.23, 95% CI 1.18-1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25-6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population. © 2021 American Society for Bone and Mineral Research (ASBMR).
髋部骨折与死亡率过高有关，这种情况会持续多年。有几个因素可能会影响生存率；然而，社会支持的作用研究得较少。居住状况可能是一个人社会支持的指标，这种指标可以预测一般人群的死亡率。在这项纵向队列研究中，我们考虑了与与伴侣一起居住相比，独居是否是髋部骨折后死亡的危险因素。2002 年至 2013 年期间，来自挪威所有医院的髋部骨折信息与 2001 年全国人口和住房普查相结合。使用灵活参数生存分析研究了 12770 名男性和 22067 名女性在骨折后 12.8 年随访期间的居住状况与死亡率之间的关系，这些患者的年龄在 50 岁至 79 岁之间。我们还估计了髋部骨折患者与具有相同居住状况（独居或与伴侣一起居住）的非骨折背景人群的相对生存率。与与伴侣一起居住的患者相比，独居的男性和女性髋部骨折患者的死亡率更高（男性 HR = 1.37，95%CI 1.29-1.44；女性 HR = 1.23，95%CI 1.18-1.28，调整年龄、教育程度、城市化程度和子女数量）。我们在年龄<60 岁的男性髋部骨折患者中观察到最强的相关性（长期死亡率 HR = 3.29，95%CI 2.25-6.49）。与一般人群相比，独居的男性髋部骨折患者 8 年后的相对生存率为 43%，女性为 61%，而与伴侣一起居住的男性和女性的相对生存率分别为 51%和 67%。总之，独居的髋部骨折患者的死亡率高于与伴侣一起居住的患者，与一般人群相比生存率更低。
