Mortality in British hip fracture patients, 2000–2010: A population-based retrospective cohort study

Highlights

• One-year mortality declined between 2000-2010 amongst elderly hip fracture patients.

• Relative mortality (hip fracture patients versus controls) remained unaltered.

• Implementation of best practice for hip fracture care should continue.

Abstract

Background

Data on recent trends in mortality after hip fracture are scarce. Aims were therefore to examine secular trends in all-cause and cause-specific mortality post hip fracture and to compare this to the general population from 2000 to 2010.

Methods

Population-based cohort study within the United Kingdom Clinical Practice Research Datalink and linked to cause of death data for 57.7% of patients. Patients with a first hip fracture (n = 31,495) were matched to up to four controls by age, sex, index date, and practice. All subjects were followed for death, and lifestyle, disease and medication history adjusted hazard ratios (HRs) were calculated.

Results

One-year all-cause mortality after hip fracture declined from 2009 and was 14% lower after, compared with before 2009 (22.3% to 20.5%, adj. HR 0.86, 95% CI: 0.81–0.92). The decline was observed for males (≥ 75 years) and females (≥ 85 years). Significant contributors to the decline in mortality post hip fracture were respiratory infections in females as were malignant diseases in males. However, one-year all-cause mortality remained unaltered over the decade when compared to controls with a 3.5-fold and 2.4-fold increased risk in males and females respectively. No significant changes were observed in the relative risks for one-year cause-specific mortality for both genders.

Conclusions

One-year mortality after hip fracture has declined over the last decade in the UK. However, the difference in one-year mortality between hip fracture patients and the general population remained unaltered. These observations highlight the need for the continued implementation of evidence-based standards for good hip fracture care.

Introduction

Hip fractures are a major public health concern in terms of morbidity, healthcare costs and mortality. A large meta-analysis showed that mortality in the year post hip fracture ranges from 20% to 26% amongst elderly females and males respectively. When compared to patients without hip fracture, mortality is 2 -to 4-fold higher in the subsequent year, and is higher for men than for women at any given age. This excess mortality persists even for ten years following the fracture [1]. Although there is little change in age-standardised hip fracture rates in the United Kingdom, the absolute number of hip fractures will continue to rise due to the ageing of the population [2].

Despite the advances in the surgical and medical management of hip fracture data on recent trends in mortality are scarce. Secular trends for mortality after hip fracture have been reported from 1968 through 1998 in the United Kingdom. Between 1968–73 and 1979–83 there was a significant decline in one-year mortality and this stabilised in the period thereafter [3]. A US study that used 20% of all Medicare claims found no reduction in one-year mortality from 1995 to 2005 [4]. Conversely, a study in Texas reported a significant decrease in hip fracture-related mortality by 0.8% per year between 1990 and 2007 in males but not in females [5].

However, it remains unknown whether the difference in mortality between hip fracture patients and the general population has changed over the last decade. In addition, cause-specific trends for mortality after hip fracture remain to be determined. Therefore, the aims of this study were [1] to describe all-cause and cause-specific one-year mortality following a hip fracture between the years 2000 and 2010 and [2] to determine, over the last decade, the relative difference in (all-cause and cause-specific) mortality between individuals with a hip fracture and controls.