Department of Ophthalmology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea.
Injury. 2024 Nov;55(11):111864. doi: 10.1016/j.injury.2024.111864. Epub 2024 Sep 5.
We aimed to examine the regional disparities in secondary fracture incidence among patients with hip fractures in South Korea.
This observational, retrospective, cohort study was conducted using data of 6,213 South Korean nationals from the National Health Insurance Service-National Sample Cohort (2004-2019). Secondary fractures included hip, wrist, humerus, spine, ankle, and pelvis fractures that occurred 6 months after hip fracture. The position value for relative composite index was used to identify medically vulnerable regions. Cox proportional hazards models were used for statistical analysis.
Among the 6,213 (1,949 male, 4,264 female) patients with hip fracture, 981 lived in medically vulnerable areas and 5,232 in non-vulnerable areas. Patients residing in vulnerable areas had a higher risk of secondary fractures than did those residing in non-vulnerable areas (hazard ratio [HR]: 1.24, 95 % confidence interval [CI]: 1.05-1.47); the factors that increased their risk included female sex (HR: 1.30, 95 % CI: 1.08-1.57), age ≥71 years (HR: 1.23, 95 % CI: 1.01-1.44), and not receiving osteoporosis medication (HR: 1.47, 95 % CI: 1.14-1.89). Ten years after hip fracture surgery, the risk of secondary fracture more than tripled in the vulnerable areas than that in the non-vulnerable areas.
Patients living in vulnerable regions had a higher risk of secondary fractures than that of those in non-vulnerable regions. Prevention and medication policies should thus be implemented to reduce regional healthcare disparities.
本研究旨在考察韩国髋部骨折患者的二次骨折发生率的区域差异。
本观察性、回顾性队列研究使用了国家健康保险服务-国家样本队列（2004-2019 年）的 6213 名韩国国民的数据。二次骨折包括髋部、腕部、肱骨、脊柱、踝部和骨盆骨折，这些骨折发生在髋部骨折后 6 个月内。相对综合指数的位置值用于确定医疗脆弱地区。使用 Cox 比例风险模型进行统计分析。
在 6213 名（男性 1949 名，女性 4264 名）髋部骨折患者中，981 名患者居住在医疗脆弱地区，5232 名患者居住在非脆弱地区。与居住在非脆弱地区的患者相比，居住在脆弱地区的患者发生二次骨折的风险更高（风险比[HR]：1.24，95%置信区间[CI]：1.05-1.47）；增加其风险的因素包括女性（HR：1.30，95%CI：1.08-1.57）、年龄≥71 岁（HR：1.23，95%CI：1.01-1.44）和未接受骨质疏松症药物治疗（HR：1.47，95%CI：1.14-1.89）。髋部骨折手术后 10 年，脆弱地区的二次骨折风险是非脆弱地区的三倍以上。
居住在脆弱地区的患者发生二次骨折的风险高于非脆弱地区的患者。因此，应实施预防和药物治疗政策，以减少区域医疗保健差异。
