School of Medicine, University of Eastern Finland, Kuopio, Finland.
Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
Osteoporos Int. 2021 Sep;32(9):1725-1733. doi: 10.1007/s00198-021-05906-6. Epub 2021 Mar 12.
In this study, we found that regional disparity in incidence of hip fractures has converged. Also, annual hip fracture risk ratios between genders have systematically diminished over time.
Several studies have reported secular trends in hip fracture incidence, but knowledge about the possible causes is limited. We studied potential explanations by examining spatio-temporal epidemiology of the fractures and estimating relative risks between genders.
This observational study was based on all inpatient hospital discharges in 1972-2018 in Finland. We divided the data by gender, 5-year age groups and Finnish sub-regions and estimated gender and age standardized spatio-temporal rates of hip fractures by using a Bayesian age-period-cohort model.
In 1972, women's hip fracture incidence was 1.2-1.3 times higher in western and coastal Finland compared to eastern and inland areas. Also, women had approximately 1.7 times higher average risk to get a hip fracture compared to men. Today, the hip fracture differences between the areas have converged to insignificant and the relative risk between genders has diminished to 1.2. Age-specific relative risks indicate greater hip fracture risk for younger men and older women, and the women's risk increases beyond the risk of men at age 65 which is ten years later than in the beginning of the study period.
Incidence of hip fracture has converged significantly between regions and genders. Especially factors related with socioeconomic development and increased frailty and longevity seem to be important. The hip fracture incidence rate ratio between women and men has systematically decreased in time, and more attention should be paid to hip fracture risk in men in the future.
本研究发现，髋部骨折发病率的地区差异已经趋同。此外，男女髋部骨折年风险比随时间推移呈系统性下降。
多项研究报告了髋部骨折发病率的长期趋势，但对其潜在原因的了解有限。我们通过研究骨折的时空流行病学并估计性别间的相对风险来探讨潜在的原因。
本观察性研究基于芬兰 1972 年至 2018 年所有住院患者的出院记录。我们按性别、5 岁年龄组和芬兰分区进行了数据划分，并使用贝叶斯年龄-时期-队列模型来估计髋部骨折的性别和年龄标准化时空率。
1972 年，与东部和内陆地区相比，芬兰西部和沿海地区女性髋部骨折的发病率高 1.2-1.3 倍。此外，女性髋部骨折的平均风险约为男性的 1.7 倍。如今，地区间的髋部骨折差异已趋同且不显著，性别间的相对风险已降至 1.2。年龄特异性相对风险表明，年轻男性和老年女性髋部骨折风险更高，且女性的风险在 65 岁时超过男性，比研究开始时晚了 10 年。
髋部骨折在地区和性别之间的发病率已显著趋同。特别是与社会经济发展以及脆弱性和寿命增加相关的因素似乎很重要。女性与男性的髋部骨折发病率比值随时间推移呈系统性下降，未来应更加关注男性的髋部骨折风险。
