Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study

Abstract

Objectives: This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only.

Methods: The World Hip Trauma Evaluation has previously reported changes in HRQoL using EuroQol-5D for patients with hip fractures. We performed additional analysis to investigate the effect of including or excluding those patients who died during the first four months of the follow-up period.

Results: The dataset included 503 patients, 25 of whom died between 30 days and four months of injury. There was a statistically significant difference in 30-day HRQoL between those alive (mean 0.331 and standard deviation (sd) 0.360) and those dead (mean 0.156 and sd 0.421) by four months (independent-samples t-test; p 0.022). The estimated difference of 0.175 in HRQoL (95% confidence interval 0.025 to 0.325) was also highly clinically significant.

Conclusion: When reporting HRQoL for patients after a hip fracture, excluding patients who die during follow-up leads to an overestimate of the effects of the intervention or treatment pathway. We would recommend that death-adjusted estimates should be used routinely when reporting HRQoL in this population.Cite this article: N. Parsons, X. L. Griffin, J. Achten, T. J. Chesser, S. E. Lamb, M. L. Costa. Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study. Bone Joint Res 2018;7:1-5.

Keywords: EQ-5D; Health-related quality of life; Hip fracture; Longitudinal models.

Fig. 1

Strip plots and box plots of four-week EuroQol 5 Dimensions (EQ-5D) data. For those World Hip Trauma Evaluation study participants alive (n = 478) and those who died (n = 25) at four months postoperatively. Stacked bars show numbers of participants for each EQ-5D score and box plots show interquartile range (IQR; box), median (solid line) and whiskers at 1.5 times the IQR.

Longitudinal models for postoperative EuroQol 5 Dimensions (EQ-5D) from the full World Hip Trauma Evaluation study population (n = 503) (a), for participants alive at four months (n = 478) (b) and for participants who had died at four months (n = 25) (c). Observed means are plotted, with 95% confidence intervals (bars) and also fitted curves with 50% confidence regions.