Tayyab Muhammad, Tanveer Muhammad, Ahmad Zawar, Khan Ameer Afzal, Syed Rahman, Shabir Muhammad, Khan Anfal, Afridi Asif, Ali Mohsin, Syed Fazal
Department of Trauma and Orthopaedics, Bradford Teaching Hospitals, Bradford, GBR.
Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stafford, GBR.
Cureus. 2025 Aug 17;17(8):e90305. doi: 10.7759/cureus.90305. eCollection 2025 Aug.
Background and aim Hip fractures are a major cause of morbidity and mortality among the aging U.S. population. Despite advances in preventive strategies and fracture management, mortality following hip fractures remains a critical public health concern. This study aimed to analyze the national trends in hip fracture-related mortality among adults aged 65 years and older in the United States from 1999 to 2023 using the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data. Methods We conducted a retrospective, population-based analysis using the CDC WONDER multiple cause-of-death database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the direct method standardized to the 2000 U.S. population. Joinpoint regression analysis was used to calculate annual percent changes (APCs) and identify significant shifts in mortality trends by sex, race/ethnicity, urbanization, U.S. census region, and state. Results Between 1999 and 2023, there were 334,905 hip fracture-related deaths among adults aged ≥65 years. The overall AAMR declined from 37.07 in 1999 to 23.91 in 2023. A significant decrease was observed from 2002 to 2018 (annual percent change (APC): -2.85%; 95% confidence interval (CI): -3.02 to -2.69; <0.001), with a more recent decline from 2021 to 2023 (APC: -4.37%; 95% CI: -8.23 to -0.33; =0.036). Both men and women showed significant long-term mortality reductions, with men experiencing a steeper decline. Racial disparities were evident, with the largest declines among the American Indian or Alaska Native individuals (APC: -4.01%; <0.001). Non-metropolitan areas had higher mortality than metropolitan areas. Regionally, the Midwest had the highest AAMRs, while Montana, Colorado, and Minnesota recorded the highest state-level rates in 2023. Conclusion Hip fracture-related mortality among older adults in the United States has declined significantly over the past two decades, though recent trends suggest a plateau in some subgroups. Persistent disparities by race, sex, geography, and urbanization highlight the need for targeted public health interventions and equitable access to post-fracture care across the aging population.
髋部骨折是美国老年人群发病和死亡的主要原因。尽管在预防策略和骨折管理方面取得了进展，但髋部骨折后的死亡率仍然是一个关键的公共卫生问题。本研究旨在利用美国疾病控制与预防中心的广泛流行病学研究在线数据（CDC WONDER）分析1999年至2023年美国65岁及以上成年人中与髋部骨折相关的死亡率的全国趋势。
我们使用CDC WONDER多死因数据库进行了一项基于人群的回顾性分析。采用直接法将每10万人口的年龄调整死亡率（AAMR）标准化为2000年美国人口。采用Joinpoint回归分析计算年度百分比变化（APC），并按性别、种族/族裔、城市化程度、美国人口普查区域和州确定死亡率趋势的显著变化。
1999年至2023年期间，65岁及以上成年人中有334,905例与髋部骨折相关的死亡。总体AAMR从1999年的37.07降至2023年的23.91。2002年至2018年观察到显著下降（年度百分比变化（APC）：-2.85%；95%置信区间（CI）：-3.02至-2.69；<0.001），最近2021年至2023年也有下降（APC：-4.37%；95%CI：-8.23至-0.33；=0.036）。男性和女性的长期死亡率均显著降低，男性下降幅度更大。种族差异明显，美国印第安人或阿拉斯加原住民个体下降幅度最大（APC：-4.01%；<0.001）。非都市地区的死亡率高于都市地区。在地区方面，中西部地区的AAMR最高，而蒙大拿州、科罗拉多州和明尼苏达州在2023年的州级死亡率最高。
在过去二十年中，美国老年人中与髋部骨折相关的死亡率显著下降，尽管最近的趋势表明一些亚组出现了平稳状态。种族、性别、地理和城市化方面持续存在的差异凸显了有针对性的公共卫生干预措施以及为老年人群提供公平的骨折后护理的必要性。
