Schürch M A, Rizzoli R, Mermillod B, Vasey H, Michel J P, Bonjour J P
World Health Organization Collaborating Center for Osteoporosis and Bone Disease, Department of Internal Medicine, University Hospital of Geneva, Switzerland.
J Bone Miner Res. 1996 Dec;11(12):1935-42. doi: 10.1002/jbmr.5650111215.
A prospective survey of hip fracture incidence and outcome was conducted to evaluate their socioeconomic impact. Over the course of 1 year, 404 hip fractures were recorded in 339 women and 65 men following minor or moderate trauma. The subjects' ages were 82.8 +/- 10.0 years (mean +/- SD): 84.1 +/- 9.2 in female and 76.4 +/- 13.7 in male subjects. The overall annual incidence was 104.4/100,000; the incidence in women was 167.1 versus 35.3 in men, with a crude female-to-male ratio of 4.7. However, when adjusted for age, this ratio was 2.7. When adjusted to the 1985 U.S.A. population, the incidence rates were 68.6 overall, 108.8 female, and 26.3 male, and were, respectively, 119.1, 188.8, and 46.1 when adjusted to the 1992 Swiss population. As compared with 105 age-matched non-hip-fracture fallers studied in the same emergency ward, fracture subjects lived more often in nursing homes and took cardiovascular drugs (p < 0.001). The mean length of stay in the orthopedic ward was 16.3 +/- 12.0 days (median 14; range 2-193 days), for a total of 6566 bed-days representing 19.8% of available bed-days. The mean length of stay in rehabilitation hospitals was 63.6 +/- 52.6 days (median 50; range 2-349 days), for a total of 17,099 bed-days, representing 5.2% of available bed-days. For patients who where independent before fracture, the greater length of stay was associated with advanced age and consumption of cardiovascular drugs. The total cost of hospital stay amounted to approximately $44,000 per patient. Mortality was 3.2% in the orthopedic ward and 10.8% in rehabilitation hospitals, for an overall in-hospital mortality rate of 10.4%. Overall, the 1-year mortality was 23.8% (21.5% for women and 35.4% for men), and it was significantly higher than in the general population (p < 0.001). Prognostic factors for mortality were age, sex, consumption of cardiovascular drugs, and previous living circumstances. One year after fracture, 62.6% of the fracture patients had returned to their previous living circumstances, but 17.9% needed a more care-intensive environment. The likelihood of returning to autonomous living circumstances 1 year after fracture was higher in younger subjects, in females, in those living with a partner, and in those in overall better health before the fracture. This prospective survey highlights the high socioeconomic impact and burden of osteoporotic fractures of the proximal femur.
开展了一项关于髋部骨折发病率及预后的前瞻性调查，以评估其社会经济影响。在1年的时间里，记录了339名女性和65名男性在遭受轻度或中度创伤后发生的404例髋部骨折。受试者年龄为82.8±10.0岁（均值±标准差）：女性为84.1±9.2岁，男性为76.4±13.7岁。总体年发病率为104.4/100,000；女性发病率为167.1，男性为35.3，粗女性与男性发病率之比为4.7。然而，经年龄调整后，该比例为2.7。调整至1985年美国人口时，总体发病率为68.6，女性为108.8，男性为26.3；调整至1992年瑞士人口时，分别为119.1、188.8和46.1。与在同一急诊病房研究的105名年龄匹配的非髋部骨折跌倒者相比，骨折患者更常居住在养老院且服用心血管药物（p<0.001）。骨科病房的平均住院时间为16.3±12.0天（中位数14天；范围2 - 193天），共计6566床日，占可用床日的19.8%。康复医院的平均住院时间为63.6±52.6天（中位数50天；范围2 - 349天），共计17,099床日，占可用床日的5.2%。对于骨折前独立生活的患者，住院时间延长与高龄及心血管药物的使用有关。每位患者的住院总费用约为44,000美元。骨科病房的死亡率为3.2%，康复医院为10.8%，总体住院死亡率为10.4%。总体而言，1年死亡率为23.8%（女性为21.5%，男性为35.4%），显著高于普通人群（p<0.001）。死亡率的预后因素为年龄、性别、心血管药物的使用及先前的生活状况。骨折后1年，62.6%的骨折患者恢复到先前的生活状况，但17.9%的患者需要更密集的护理环境。骨折后1年恢复自主生活状况的可能性在较年轻的受试者、女性、与伴侣同住者以及骨折前总体健康状况较好者中更高。这项前瞻性调查凸显了股骨近端骨质疏松性骨折的高社会经济影响和负担。
