Loss of life years after a hip fracture

Abstract

Background: Patients with a hip fracture have a high mortality; however, it is not clear how large the loss of life-years is over an extended observation period.

Subjects and methods: This was a cohort study involving all patients in Denmark who suffered a hip fracture between 1977 and 2001 (n = 169,145). The survival rate for these patients was compared to that for age- and sex-matched subjects without a hip fracture (n = 524,010).

Results: There was a substantial degree of excess mortality, with a pronounced variation in age and sex. The absolute number of life-years lost compared to age-matched subjects without a hip fracture was larger in younger subjects than in older subjects (men aged 51-60 years lived 7.5 years less on average while men over 80 years of age lived 3 years less). Expressed as a percentage, however, older subjects had the largest relative loss of expected remaining years of life. Men < or = 50 years of age lost 18% of their expected remaining years of life, as opposed to men > 80 years of age who lost as much as 58% of their expected remaining years of life. In women, the trend was similar but less pronounced (27% loss in women < or = 50 years of age vs. 38% in women > 80 years of age).

Interpretation: A large proportion of the estimated remaining life is lost after a hip fracture, even in younger patients. Prevention may save life years, although not all of the years lost after a hip fracture may be due to the hip fracture per se.

Figure 1.

Actuarial survival in patients with a hip fracture and matched controls with no hip fracture, all of whom were ≤ 50 years (a), 51–60 years (b), 61–70 years (c), 71–80 years (d) or > 80 years (e) of age at the time of hip fracture (or matched dummy date in the case of matched controls).