The Association of Race, Gender, and Comorbidity With Mortality and Function After Hip Fracture

Abstract

Background Few studies of hip fracture have large enough samples of men, minorities, and persons with specific comorbidities to examine differences in their mortality and functional outcomes. To address this problem, we combined three cohorts of hip fracture patients to produce a sample of 2692 patients followed for 6 months. Method Data on mortality, mobility, and other activities of daily living (ADLs) were available from all three cohorts. We used multiple regression to examine the association of race, gender, and comorbidity with 6-month survival and function, controlling for prefracture mobility and ADLs, age, fracture type, cohort, and admission year. Results The mortality rate at 6 months was 12%: 9% for women and 19% for men. Whites and women were more likely than were nonwhites and men to survive to 6 months, after adjusting for age, comorbidities, and prefracture mobility and function. Whites were more likely than were nonwhites to walk independently or with help at 6 months compared to not walking, after adjusting for age, comorbidities, and prefracture mobility and function. Dementia had a negative impact on survival, mobility, and ADLs at 6 months. The odds of survival to 6 months were significantly lower for people with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and/or cancer. Parkinson’s disease and stroke had negative impacts on mobility and ADLs, respectively, among survivors at 6 months. Conclusions The finding of higher mortality and worse mobility for nonwhite patients with hip fractures highlights the need for more research on race/ethnicity disparities in hip fracture care.

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

“…In addition, many (71%) were unable to live in conditions similar to those before the (77) These outcomes are similar to long-term outcomes for people with femoral neck fractures. (78)(79)(80)(81) A comprehensive review of 6409 femoral shaft fractures in Swedish inpatients showed a bimodal age distribution of incidence in both males and females, (82) similar to that reported by Singer and colleagues. (83) The age-specific incidence rates (per 100,000) for subtrochanteric fractures increased between the 65-and 85-year categories in both males and females in Iran, (84) in the United States, (85) and in the United Kingdom.…”

Effect of pre-fracture mobility on the early post-operative functional outcome in elderly patients with a hip fracture

“…In the study by the NMS was used to determine pre fracture functional level and participants were admitted from their own homes. Similar findings have also been reported by Penrod et al, (2008) and Parker and Palmer, (1993). reported that 50% of participants used a walking aid prior to the fracture.…”

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

“…Several studies document comorbid diseases and prefracture health status are associated with the 1-year postfracture mortality [28,46,52], whereas others show no influence of these factors [10,55]. Studies from developed countries suggest preoperative factors increasing the risk of mortality are race (nonwhite) [27,42], old age [10,12,28,52], presence of dementia [24,42], male gender [12,24,33,42], serious concomitant illness [10,12,33,52], low body mass index (BMI) [24], low handgrip strength [37], not walking outdoors before fracture [37], history of hip fracture [4], delirium at admission [9], postoperative complications [46], high preoperative risk score [24,44], and postoperative mobility [25]. In developing countries, orthopaedic services are less available.…”