Trends in Hip Fracture Incidence, Recurrence, and Survival by Education and Comorbidity: A Swedish Register-based Study

Abstract

Background: Hip fractures are common and severe conditions among older individuals, associated with high mortality, and the Nordic countries have the highest incidence rates globally. With this study, we aim to present a comprehensive picture of trends in hip fracture incidence and survival in the older Swedish population stratified by education, birth country, and comorbidity level. Methods: This study is based on a linkage of several population registers and included the entire population over the age of 60 living in Sweden. We calculated age-standardized incidence rates for first and recurrent hip fractures as well as age-standardized proportions of patients surviving 30 and 365 days through the time period 1998 to 2017. We calculated all outcomes for men and women in the total population and in each population stratum. Results: Altogether, we observed 289,603 first hip fractures during the study period. Age-standardized incidence rates of first and recurrent fractures declined among men and women in the total population and in each educational-, birth country-, and comorbidity group.Declines in incidence were more pronounced for recurrent than for first fractures. Approximately 20% of women and 30% of men died within 1 year of their first hip fracture. Overall, survival proportions remained constant throughout the study period but improved when taking into account comorbidity level. Conclusions: Hip fracture incidence has declined across the Swedish population, but mortality after hip fracture remained high, especially among men. Hip fracture patients constitute a vulnerable population group with increasing comorbidity burden and high mortality risk.

The ASA score predicts infections, cardiovascular complications, and hospital readmissions after hip fracture - A nationwide cohort study

“…Moreover, we found no apparent sex differences in the relationship between ASA and any of the complications included in this study. This suggests that the ASA score is equally predictive for complications among men and women although male hip fracture patients have higher comorbidity levels and higher mortality rates than women [ 2 ].…”

“…Hip fractures often affect frail older patients for which complications, such as infections, can be life-threatening. As a result, one in four patients dies within 1 year [ 2 ]. Identifying individuals at risk of serious complications is thus of great interest for patients and clinicians.…”

Admission Resting Heart Rate as an Independent Predictor of All-Cause Mortality in Elderly Patients with Hip Fracture

“…Patient comorbidity was assessed with the Charlson comorbidity index (CCI), which is one of the most widely used comorbidity models. 12 Moreover, admission laboratory data related to the prognosis of hip fracture patients were also obtained, including lymphocyte [reference range: (1.1–3.2) × 10 9 /L], hemoglobin (reference range: 130.0–175.0 g/L), and albumin (reference range: 35.0–55.0 g/L).…”

“…The CCI score was calculated based on 17 diseases, and categorized as none (CCI = 0), low (CCI = 1) and high (CCI ≥ 2). 12 Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking any antihypertensive drugs. According to the lower limit of reference range, lymphopenia and hypoalbuminemia were defined as an absolute lymphocyte count < 1.1 × 10 9 /L and serum albumin < 35.0 g/L, respectively.…”

Changes in Characteristics and Outcomes of Patients Undergoing Surgery for Hip Fractures Following the Initiation of Orthogeriatric Service: Temporal Trend Analysis

“…Hip fracture is a common condition in older people, sharing the largest proportion of hospital admissions amongst all types of fractures [1]. Patients with a hip fracture have increased risk of many adverse outcomes in hospital including prolonged hospitalisation, malnutrition, pressure ulcers, mortality and requirement for higher levels of care [2][3][4][5][6]. Consequently, the personal and social costs of hip fractures are enormous [7,8].…”