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. 2025 May 28;15(1):18747.
doi: 10.1038/s41598-025-03835-6.

Sex modified the association between cognitive impairment and 1-year mortality in older adults with hip fractures

Zhi Yang  1 , Yi-Dian Wang  1 , Bin-Fei Zhang  2
Affiliations

Sex modified the association between cognitive impairment and 1-year mortality in older adults with hip fractures

Zhi Yang et al. Sci Rep. .

Abstract

To assess the role of sex-based influence on cognitive impairment and 1-year mortality in older adults with hip fractures. In this retrospective cohort study, we included older patients who experienced a hip fracture between 1 January 2015 and 30 September 2019. Demographic and clinical data of patients were obtained from original medical records. We contacted the patient's family members by telephone to record data on survival. The endpoint was all-cause mortality. Univariate and multivariate binary logistic regression models were used to build relationships between cognitive impairment and 1-year mortality. Overall, 2589 patients were included in this study, containing 835 males and 1754 females. One hundred five patients had cognitive impairment. The mean age was 79.60 (6.78) and 81.26 (5.84) years in the no cognitive and cognitive impairment groups. There were 286 (11.0%) patients who died after 1 year. Multivariate binary logistic regression showed that cognitive impairment was associated with increased 1-year mortality in hip fracture patients after correction for confounders (OR = 2.14, 95% CI: 1.2-3.82, P < 0.001). Also, the study found that cognitive impairment in male patients have an even higher 1-year mortality following hip fracture (OR = 5.96, 95% CI: 2.40-14.78, P < 0.0001). The interaction between males and females was P = 0.0171. The 1-year mortality was higher in older male patients with hip fractures and cognitive impairment. Cognitive impairment was associated with increased mortality in older adults with hip fractures. Notably, sex was a factor modifying this association, and male patients with cognitive impairment have an even higher 1-year mortality. Registration: ChiCTR2200057323.

Keywords: Cognitive impairment; Hip fractures; Mortality; Sex.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Honghui Hospital, Xi’an Jiaotong University (No. 202201009). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Registered information: This study is registered with the (Chinese Clinical Trial Registry, ChiCTR) and the number is ChiCTR2200057323. Consent to publish: The work described has not been published before (except in the form of an abstract or as part of a published lecture, review, or thesis); it is not under consideration for publication elsewhere, and all co-authors have approved its publication.

Figures

Fig. 1
Fig. 1
The flow diagram.
Fig. 2
Fig. 2
Kaplan-Meier survival.
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