Department of Rheumatology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France.
Department of Medical Information, Lille University Hospital, Lille, France.
JAMA Netw Open. 2021 Nov 1;4(11):e2134972. doi: 10.1001/jamanetworkopen.2021.34972.
The COVID-19 pandemic has posed a number of unprecedented challenges to the health care system in France, where hip fractures in the elderly population are a major public health concern.
To explore the association of the first nationwide COVID-19 lockdown in France with the absolute number of hip fractures among patients 50 years or older.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the French national hospitals database to identify patients 50 years or older who were hospitalized for hip fracture in France from January to July 2019 and January to July 2020.
The first nationwide COVID-19 lockdown in France from March 16 to May 10, 2020.
The main outcome was the number of hospitalizations for hip fracture from January to July 2020 (study period) compared with the number of hospitalizations for hip fracture during the same period in 2019 (control period). Hospitalization rate ratios (HRRs) comparing the study period with the control period were calculated for 3 intervals (before lockdown [January 1 to March 15], during lockdown [March 16 to May 10], and after lockdown [May 11 to July 31]) and were stratified by gender, age and hospital type.
The study included 46 393 patients hospitalized for hip fracture during January to July 2019 (34 589 [74.4%] women; mean [SD] age, 82.8 [10.5] years) and 44 767 patients hospitalized for hip fracture from January to July 2020 (33 160 [74.1%] women; mean [SD] age, 82.9 [10.5] years). During the lockdown in 2020, 10 429 patients (23.30%) were hospitalized for hip fracture compared with 11 782 patients (25.40%) during the same period in 2019 (HRR, 0.89; 95% CI, 0.86-0.91; P < .001). The lockdown period was associated with a decrease in the number of hip fractures of 11% among women (from 8756 in 2019 to 7788 in 2020) and 13% among men (from 3026 in 2019 to 2641 in 2020). When the absolute number of hip fractures was stratified by age group, the lockdown period was associated with a decrease in the number of hip fractures in all age groups except in patients older than 89 years (HRR, 0.97; 95% CI, 0.92-1.01; P = .17). In the group of patients aged 80 to 89 years, the number of hip fractures decreased from 4925 to 4370 (HRR, 0.89; 95% CI, 0.85-0.92; P < .001). During the lockdown, hospitalizations decreased by 33% (HRR, 0.67; 95% CI, 0.63-0.71; P < .001) in public university hospitals and by 24% (HRR, 0.76; 95% CI, 0.73-0.79; P < .001) in public general hospitals but increased by 46% (HRR, 1.46; 95% CI,1.38-1.54; P < .001) in private for-profit hospitals.
In this cohort study, hospitalizations for hip fractures in France decreased by 11% during the first nationwide COVID-19 lockdown. Further studies are needed to investigate the long-lasting consequences of the COVID-19 pandemic on the incidence of osteoporotic fractures.
COVID-19 大流行给法国的医疗体系带来了许多前所未有的挑战，老年人髋部骨折是法国主要的公共卫生问题。
探讨法国首次全国范围的 COVID-19 封锁与 50 岁及以上人群髋部骨折绝对数量之间的关联。
设计、地点和参与者：本回顾性队列研究使用法国国家医院数据库的数据，确定了 2019 年 1 月至 7 月和 2020 年 1 月至 7 月期间在法国因髋部骨折住院的 50 岁及以上的患者。
法国于 2020 年 3 月 16 日至 5 月 10 日实施了首次全国范围的 COVID-19 封锁。
主要结局是 2020 年 1 月至 7 月（研究期间）与 2019 年同期（对照期间）相比髋部骨折住院人数。为 3 个间隔（封锁前[1 月 1 日至 3 月 15 日]、封锁期间[3 月 16 日至 5 月 10 日]和封锁后[5 月 11 日至 7 月 31 日]）计算了研究期间与对照期间的住院率比值（HRR），并按性别、年龄和医院类型进行分层。
该研究纳入了 2019 年 1 月至 7 月期间因髋部骨折住院的 46393 例患者（34589 例[74.4%]为女性；平均[标准差]年龄为 82.8[10.5]岁）和 2020 年 1 月至 7 月期间因髋部骨折住院的 44767 例患者（33160 例[74.1%]为女性；平均[标准差]年龄为 82.9[10.5]岁）。在 2020 年的封锁期间，与 2019 年同期相比，10429 例（23.30%）患者因髋部骨折住院，而 11782 例（25.40%）患者因髋部骨折住院（HRR，0.89；95%CI，0.86-0.91；P<.001）。封锁期间，女性髋部骨折的数量减少了 11%（从 2019 年的 8756 例减少到 2020 年的 7788 例），男性髋部骨折的数量减少了 13%（从 2019 年的 3026 例减少到 2020 年的 2641 例）。当按年龄组划分绝对髋部骨折数量时，除 89 岁以上的患者外，封锁期间髋部骨折的数量均有所减少（HRR，0.97；95%CI，0.92-1.01；P=.17）。在 80 至 89 岁的患者组中，髋部骨折的数量从 4925 例减少到 4370 例（HRR，0.89；95%CI，0.85-0.92；P<.001）。封锁期间，公立大学医院的住院人数减少了 33%（HRR，0.67；95%CI，0.63-0.71；P<.001），公立医院减少了 24%（HRR，0.76；95%CI，0.73-0.79；P<.001），而私立盈利性医院则增加了 46%（HRR，1.46；95%CI，1.38-1.54；P<.001）。
在这项队列研究中，法国的髋部骨折住院人数在首次全国范围的 COVID-19 封锁期间减少了 11%。需要进一步研究 COVID-19 大流行对骨质疏松性骨折发病率的长期影响。
