夏威夷骨质疏松性髋部骨折后 1 年死亡率的相关风险因素：夏威夷原住民和其他太平洋岛民的死亡率风险更高。

Risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawai'i: higher mortality risk among Native Hawaiians and other Pacific Islanders.

机构信息

John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA.

Biostatistics Core Facility, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA.

出版信息

Osteoporos Int. 2024 Nov;35(11):1931-1941. doi: 10.1007/s00198-024-07195-1. Epub 2024 Jul 30.

DOI:10.1007/s00198-024-07195-1

PMID:39080035

Abstract

UNLABELLED

We studied factors affecting osteoporotic hip fracture mortality in Hawai'i, a region with unique geography and racial composition. Men, older adults, higher ASA score, lower BMI, and NHPI race were associated with higher mortality. This is the first study demonstrating increased mortality risk after hip fracture in NHPI patients.

PURPOSE

To estimate mortality rates and identify specific risk factors associated with 1-year mortality after osteoporotic hip fracture in Hawai'i.

METHODS

A retrospective review of adults (≥ 50 years) hospitalized with an osteoporotic hip fracture at a large multicenter healthcare system in Hawai'i from 2011 to 2019. The Kaplan-Meier curves and log-rank tests examined survival probability by sex, age group, race/ethnicity, primary insurance, body mass index (BMI), and American Society of Anesthesiologists (ASA) physical status classification. After accounting for potential confounders, adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were obtained from Cox proportional hazards regression models.

RESULTS

We identified 1755 cases of osteoporotic hip fracture. The cumulative mortality rate 1 year after fracture was 14.4%. Older age (aHR 3.50; 95% CI 2.13-5.76 for ≥ 90 vs 50-69), higher ASA score (aHR 5.21; 95% CI 3.09-8.77 for ASA 4-5 vs 1-2), and Native Hawaiian/Pacific Islander (NHPI) race (aHR 1.84; 95% CI 1.10-3.07 vs. White) were independently associated with higher mortality risk. Female sex (aHR 0.64; 95% CI 0.49-0.84 vs male sex) and higher BMI (aHR 0.35; 95% CI 0.18-0.68 for obese vs underweight) were associated with lower mortality risk.

CONCLUSION

In our study, men, older adults, higher ASA score, lower BMI, and NHPI race were associated with significantly higher mortality risk after osteoporotic hip fracture. NHPIs are an especially vulnerable group and comprise a significant portion of Hawai'i's population. Further research is needed to address the causes of higher mortality and interventions to reduce hip fractures and associated mortality.

摘要

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我们研究了影响夏威夷骨质疏松性髋部骨折死亡率的因素，该地区具有独特的地理位置和种族构成。男性、老年人、较高的 ASA 评分、较低的 BMI 和 NHPI 种族与更高的死亡率相关。这是第一项表明 NHPI 患者髋部骨折后死亡风险增加的研究。

目的

估计骨质疏松性髋部骨折后 1 年的死亡率，并确定与夏威夷骨质疏松性髋部骨折后 1 年死亡率相关的特定风险因素。

方法

对在夏威夷一家大型多中心医疗保健系统因骨质疏松性髋部骨折住院的成年人（≥50 岁）进行回顾性研究，时间为 2011 年至 2019 年。通过 Kaplan-Meier 曲线和对数秩检验，按性别、年龄组、种族/族裔、主要保险、体重指数（BMI）和美国麻醉师协会（ASA）身体状况分类来检查生存概率。在考虑到潜在混杂因素后，使用 Cox 比例风险回归模型获得调整后的危险比（aHR）和 95%置信区间（CI）。

结果

我们确定了 1755 例骨质疏松性髋部骨折病例。骨折后 1 年的累积死亡率为 14.4%。年龄较大（aHR 3.50；95%CI 2.13-5.76，≥90 岁与 50-69 岁）、ASA 评分较高（aHR 5.21；95%CI 3.09-8.77，ASA 4-5 与 1-2）和夏威夷原住民/太平洋岛民（NHPI）种族（aHR 1.84；95%CI 1.10-3.07，与白人相比）与更高的死亡率风险独立相关。女性（aHR 0.64；95%CI 0.49-0.84，与男性相比）和较高的 BMI（aHR 0.35；95%CI 0.18-0.68，肥胖与体重不足）与较低的死亡率风险相关。