The impact of comorbidities on hip fracture mortality: a retrospective population-based cohort study

被引:16
作者
Jurisson, Mikk [1 ]
Raag, Mait [1 ]
Kallikorm, Riina [2 ,3 ]
Lember, Margus [2 ,3 ]
Uuskula, Anneli [1 ]
机构
[1] Univ Tartu, Inst Family Med & Publ Hlth, Ravila St 19, EE-50411 Tartu, Estonia
[2] Univ Tartu, Fac Med, Ravila St 19, EE-50411 Tartu, Estonia
[3] Tartu Univ Hosp, Internal Med Clin, L Puusepa St 8, EE-51014 Tartu, Estonia
关键词
Hip fracture; Mortality; Comorbidities; Charlson comorbidity index; EXCESS MORTALITY; OSTEOPOROTIC FRACTURES; ELDERLY-PATIENTS; RISK-FACTORS; OLDER WOMEN; PREVALENCE; VALIDATION; PREDICTORS; DEMENTIA; SURVIVAL;
D O I
10.1007/s11657-017-0370-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The impact of comorbidities on hip fracture-related excess mortality was assessed in a population-based age-and sex-matched cohort over 10 years. On average, only 1 out of 12 excess deaths over 10 years was related to pre-fracture life-threatening comorbidities. The presence of life-threatening comorbidities increased the excess risk of death after hip fracture. Purpose This work aimed to estimate the impact of pre-fracture comorbidities on the 10-year excess risk of all-cause death after hip fracture among Estonian men and women >= 50 years of age. Methods Retrospective, population-based 10-year study of people aged >= 50 in two cohorts: those with a hip fracture and an age-and sex-matched random sample from the national health insurance fund for comparison. Results We found that hip fracture was a strong independent risk factor for death. Upon adjustment for Charlson Comorbidities Index (CCI) score, the impact of life-threatening comorbidities on average hip fracture-related excess mortality was modest: only 8% of excess deaths over 10 years were related to comorbidities. Upon stratification by CCI groups, the excess risk of patients in CCI groups >= 3 and 1-2 exceeded that in the CCI 0 group over 5-7 years, indicating that in patients with life-threatening comorbidities, a hip fracture accelerates the chain of lethal events and brings deaths from other conditions forward. The impact of comorbidities was age-and time-dependent: in younger hip fracture patients, the comorbidities almost doubled the excess risk from a fracture in 10 years; in older patients, the effect was shorter and modest. Conclusions The presence of pre-fracture comorbidities increases the risk of excess death in hip fracture patients, but the comorbidity impact on aggregated excess mortality is modest.
引用
收藏
页数:10
相关论文
共 50 条
[1]   Excess mortality following hip fracture: a systematic epidemiological review [J].
Abrahamsen, B. ;
van Staa, T. ;
Ariely, R. ;
Olson, M. ;
Cooper, C. .
OSTEOPOROSIS INTERNATIONAL, 2009, 20 (10) :1633-1650
[2]  
Carstensen B., 2016, Epi: A package for statistical analysis in epidemiology. R package version 2.7. Available at
[3]   Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS) [J].
Cauley, Jane A. ;
Cawthon, Peggy M. ;
Peters, Katherine E. ;
Cummings, Steven R. ;
Ensrud, Kristine E. ;
Bauer, Douglas C. ;
Taylor, Brent C. ;
Shikany, James M. ;
Hoffman, Andrew R. ;
Lane, Nancy E. ;
Kado, Deborah M. ;
Stefanick, Marcia L. ;
Orwoll, Eric S. .
JOURNAL OF BONE AND MINERAL RESEARCH, 2016, 31 (10) :1810-1819
[4]   One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index [J].
Cenzer, Irena S. ;
Tang, Victoria ;
Boscardin, W. John ;
Smith, Alexander K. ;
Ritchie, Christine ;
Wallhagen, Margaret I. ;
Espaldon, Roxanne ;
Covinsky, Kenneth E. .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2016, 64 (09) :1863-1868
[5]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[6]   Cognitive Dysfunction in Hip Fracture Patients [J].
Chaudhry, Harman ;
Devereaux, Philip J. ;
Bhandari, Mohit .
ORTHOPEDIC CLINICS OF NORTH AMERICA, 2013, 44 (02) :153-+
[7]   Comorbidity and mortality following hip fracture: a population-based cohort study [J].
de Luisel, Cynthia ;
Brimacombe, Michael ;
Pedersen, Lars ;
Sorensen, Henrik T. .
AGING CLINICAL AND EXPERIMENTAL RESEARCH, 2008, 20 (05) :412-418
[8]   Effect of hip fracture on mortality in elderly women:: The EPIDOS prospective study [J].
Empana, JP ;
Dargent-Molina, P ;
Bréart, G .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2004, 52 (05) :685-690
[9]   Frailty and risk of falls, fracture, and mortality in older women: The study of Osteoporotic fractures [J].
Ensrud, Kristine E. ;
Ewing, Susan K. ;
Taylor, Brent C. ;
Fink, Howard A. ;
Stone, Katie L. ;
Cauley, Jane A. ;
Tracy, J. Kathleen ;
Hochberg, Marc C. ;
Rodondi, Nicolas ;
Cawthon, Peggy M. .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2007, 62 (07) :744-751
[10]  
Estonian Health Insurance Fund, 2015, ANN REPORT