Trends in mortality following hip fracture in older women

Abstract

Objectives: To examine contemporary trends in mortality following hip fracture among older postmenopausal women in an integrated healthcare delivery system.

Study design: Retrospective cohort study of 13,550 women aged ≥65 years with hip fracture during 2000 to 2010.

Methods: Demographic factors, comorbidity index score, fracture history, early rehospitalization, and all-cause mortality within 1 year following hip fracture were examined using health plan databases and records. Temporal trends, risk factors, and the association of race/ethnicity and mortality within 1 year post fracture were examined using multivariable logistic regression.

Results: Among 13,550 women with hip fracture, 84.6% were aged ≥75 years: 83.6% were white, 2.8% black, 5.6% Hispanic, 4.5% Asian, and 3.5% of other/unknown race. Following hip fracture, 2.4% died during the index hospitalization, while 12.3% were rehospitalized within 30 days of discharge. Infection, pneumonia, and cardiovascular conditions were the most common nonorthopedic indications for readmission. Mortality rates at 6 months (17%) and 1 year (22.8%) following hip fracture were high and increased with age. Greater comorbidity and early rehospitalization were associated with increased mortality risk, while Asian and Hispanic race/ethnicity were associated with lower mortality risk (vs white). Temporal trends demonstrated a small but significant reduction in mortality risk during 2004 to 2010.

Conclusions: While hip fracture morbidity and mortality remain high, temporal trends suggest recent declines in mortality risk, with risk of death following hip fracture lower for Asian and Hispanic women. Future studies should examine potential benefits of targeted interventions within integrated healthcare settings and factors contributing to observed racial/ethnic differences in post fracture survival.