Geographic Variation in Hip Fracture Among United States Long-Stay Nursing Home Residents

Abstract

Introduction Despite high rates of hip fracture among United States (US) nursing home (NH) residents, little is known about geographic variation in hip fracture incidence. We used nationally representative data to identify geographic variation in hip fracture among US NH residents. Design and setting Retrospective cohort study using Part A claims for a 100% of Medicare enrollees in 15,289 NHs linked to NH minimum data set and Online Survey, Certification, and Reporting databases. Participants A total of 891,085 long-stay (continuous residence of ≥100 days) NH residents ≥65 years old. Measurements Medicare Part A claims documenting a hip fracture. Mean incidence rates of hip fracture for long-stay NH residents were calculated for each state and US Census Division from 2007 to 2010. Results The age-, sex-, and race-adjusted incidence rate of hip fracture ranged from 1.49 hip fractures/100 person-years (Hawaii) to 3.60 hip fractures/100 person-years (New Mexico), with a mean of 2.38 (standard deviation 0.43) hip fractures/100 person-years. The mean incidence of hip fracture was 1.7-fold greater in the highest quintile than the lowest. Conclusions We observed modest US state and regional variation in hip fracture incidence among long-stay NH residents. Future studies should assess whether state policies or NH characteristics explain the variation.

Effect of Bisphosphonates on Fracture Outcomes Among Frail Older Adults

“…Common causes (ie, potential confounders) or proxies of common causes of treatment and outcomes were prespecified, measured in the 365‐day assessment period up to and including the index date (treatment initiation), and included in propensity score estimation (described below). The variables included demographic characteristics, medical history, medication use, health services utilization, and NH facility characteristics . MDS data were used to generate several validated scales for cognition, functioning, and frailty .…”

“…The variables included demographic characteristics, medical history, medication use, health services utilization, and NH facility characteristics. [21][22][23][24] MDS data were used to generate several validated scales for cognition, functioning, and frailty. [25][26][27] Time between long-stay qualification and treatment initiation (mean = 287 days) was included in the propensity score estimation.…”

Outcomes of “diabetes‐friendly” vs “diabetes‐unfriendly” β‐blockers in older nursing home residents with diabetes after acute myocardial infarction

“…24 skull/face (ICD-9-CM 800, 804); PPV ranges from~30% to 98% depending on fracture site]. [26][27][28][29][30] We measured all outcomes within 90 days of the NH readmission after the index AMI hospital discharge. 8…”

Proton Pump Inhibitors, Histamine-2 Receptor Antagonists, and Hip Fracture Risk among Patients on Hemodialysis

“…Consequently, we included hypertension, diabetes mellitus, coronary artery disease, cerebrovascular disease, peripheral vascular disease, arrhythmia, rheumatologic disorder, osteoporosis, depression, and tobacco use as potential confounders (see Supplemental Table 1 for specifications) (18)(19)(20)(21)(22)(23)(24). As there is precedent for geographic variation of hip fracture incidence (25,26), census division was also included in multivariable analysis. Prior bisphosphonate and steroid use was defined from Part D claims as any pharmacy-dispensed pills in the 3 years before the index date.…”