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. 2020 Oct;91(5):598-604.
doi: 10.1080/17453674.2020.1783484. Epub 2020 Jun 26.

Time trends in pediatric fractures in a Swedish city from 1950 to 2016

Erika Bergman  1 , Vasileios Lempesis  1 , Jan-Åke Nilsson  1 , Lars Jephsson  1 , Björn E Rosengren  1 , Magnus K Karlsson  1
Affiliations

Time trends in pediatric fractures in a Swedish city from 1950 to 2016

Erika Bergman et al. Acta Orthop. 2020 Oct.

Abstract

Background and purpose - As previous studies indicate time trends in pediatric fracture incidence, we followed the incidence in a Swedish city between 1950 and 2016.Patients and methods - Malmö city, Sweden had 322,574 inhabitants in 2015. We used diagnosis registry, charts, and radiographs of the only city hospital to classify fractures in individuals < 16 years in 2014-2016, and compared these with data from 1950-2006. We used joinpoint regression to analyze time trends and present results as mean annual percentage changes (APC). Differences between periods are described as incident rate ratios (IRR). To describe uncertainty, 95% confidence intervals (CI) are used.Results - During 2014-2016 the pediatric fracture incidence was 1,786 per 105 person-years (boys 2,135 and girls 1,423). From 1950 onwards age-adjusted fracture incidence increased until 1979 in both boys (APC +1.5%, CI 1.2-1.8) and girls (APC +1.6%, CI 0.8-2.5). The incidence remained stable from 1979 to 2016 (APC in boys 0.0%, CI -0.3 to 0.3 and in girls -0.2%, CI -1.1 to 0.7). Age-adjusted incidence 2014-2016 was higher than 2005-2006 in girls (IRR 1.1, CI 1.03-1.3), but not in boys (IRR 1.0, CI 0.9-1.1).Interpretation - Fracture incidence was in girls higher in 2014-2016 than in 2005-2006. However, only with more than 2 measuring points are meaningful trend analyses possible. When we analyzed the period 1950-2016 with 17 measuring points and joinpoint regression, we found that fracture incidence increased in both sexes until 1979 but has thereafter been stable.

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Figures

Figure 1.
Figure 1.
Fracture incidence per 105 person-years in boys and girls aged 0–15 years in Malmц, Sweden, during the years 2014–2016. Data are presented with 95% confidence intervals (CI 95%) per 1-year age class.
Figure 3.
Figure 3.
Fracture incidence per 105 person-years in boys (left panel) and girls (right panel) aged 0–15 years in Malmц, Sweden, during the periods 1950/1955 (study start), 2005–2006 (earlier study), and 2014–2016 (present study), representing fracture incidence during different decades.
Figure 3.
Figure 3.
Fracture incidence per 105 person-years in boys (left panel) and girls (right panel) aged 0–15 years in Malmц, Sweden, during the periods 1950/1955 (study start), 2005–2006 (earlier study), and 2014–2016 (present study), representing fracture incidence during different decades.
Figure 5.
Figure 5.
Unadjusted fracture (left panel) and age-adjusted fracture (right panel) incidence per 105 person-years in boys and girls aged 0–15 years in Malmц, Sweden, in 2014–2016 in comparison with 1950/1955, 1960/1965, 1970/1975–1979, 1993–1994, and 2005–2006. These periods are shown with thick lines, with line markers representing the number of years measured in the period. An arrow indicates the 2 compared periods with incident rate ratios (IRR) in fracture incidence with 95% confidence intervals (95% CI) presented above the arrow. aindicates statistically significant changes.
Figure 5.
Figure 5.
Unadjusted fracture (left panel) and age-adjusted fracture (right panel) incidence per 105 person-years in boys and girls aged 0–15 years in Malmц, Sweden, in 2014–2016 in comparison with 1950/1955, 1960/1965, 1970/1975–1979, 1993–1994, and 2005–2006. These periods are shown with thick lines, with line markers representing the number of years measured in the period. An arrow indicates the 2 compared periods with incident rate ratios (IRR) in fracture incidence with 95% confidence intervals (95% CI) presented above the arrow. aindicates statistically significant changes.
Figure 6.
Figure 6.
Age-adjusted fracture incidence per 105 person years in boys and girls aged 0–15 in Malmц, Sweden, during the years 1950–2016, estimated with joinpoint regression. aindicates statistically significant changes.
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