Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
Department of Surgery, Nordland Hospital Trust, Vesteraalen Hospital, Stokmarknes, Norway.
Bone Joint J. 2022 Jul;104-B(7):884-893. doi: 10.1302/0301-620X.104B7.BJJ-2021-1806.R1.
This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality.
Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population.
Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors.
Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population. Cite this article: 2022;104-B(7):884-893.
本研究旨在确定髋部骨折后死亡的风险因素（患者、医疗保健系统和社会经济），并评估其相对重要性。此外，我们旨在阐明骨折后的死亡率和生存模式以及超额死亡率的持续时间。
2014 年 1 月至 2018 年 12 月期间，对挪威髋部骨折登记处的 37394 例髋部骨折患者的数据进行了链接，并与挪威患者登记处、挪威统计局以及急症护理医院特征的数据进行了链接。采用 Cox 回归分析来估计与死亡率相关的风险因素。使用 Wald 统计量来评估和说明风险因素的相对重要性，这些因素分为可修改（与医疗保健相关）和不可修改（患者相关和社会经济）。我们计算了标准化死亡率比（SMR），将髋部骨折患者的死亡人数与标准参考人群中的预期死亡人数进行比较。
平均年龄为 80.2 岁（标准差 11.4），67.5%（n=25251）为女性。患者因素（男性、合并症增加（美国麻醉医师协会分级和 Charlson 合并症指数））、社会经济因素（低收入、低教育水平、居住在医疗保健机构）和医疗保健因素（髋部骨折量、提供老年骨科服务）与死亡率增加相关。不可修改的风险因素与死亡率的相关性强于可修改的风险因素。SMR 分析表明，髋部骨折患者在第一年的累积超额死亡率为 16%，在第六年为 41%。在六年的观察期内，SMR 为 2.48，在第一年最为明显，从第一个月的 10.92 降至 12 个月后的 3.53 和六年后的 2.48。中位生存时间存在显著差异，特别是与患者相关的因素。
社会经济、患者和医疗保健相关因素均导致超额死亡率增加，不可修改因素与死亡率的相关性强于可修改因素。髋部骨折导致了大量的超额死亡。在这个老年人群中，明显较小的生存差异转化为中位生存时间的显著差异。
