Relative mortality in U.S. Medicare beneficiaries with Parkinson disease and hip and pelvic fractures.
Relative mortality in U.S. Medicare beneficiaries with Parkinson disease and hip and pelvic fractures.
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DOI：
10.2106/jbjs.l.01317
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发表时间：
2014-02-19
期刊：
影响因子：
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通讯作者：
Racette, Brad A
中科院分区：
文献类型：
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作者：
Harris-Hayes, Marcie;Willis, Allison W;Racette, Brad A
背景：帕金森病是一种影响步态和姿势稳定性的神经退行性疾病，导致跌倒风险增加。本研究的目的是评估帕金森病患者髋部或骨盆（髋部/骨盆）骨折后与人口统计学因素相关的死亡率。第二个目标是比较与帕金森病相关的死亡率与其他常见的医疗条件的患者髋关节/骨盆fracture.METHODS：这是一个回顾性观察队列研究的1,980,401老年医疗保险受益人诊断髋关节/骨盆骨折从2000年至2005年谁被确定与使用受益人年度摘要文件。样本的人种/种族分布为白色（93.2%）、黑人（3.8%）、西班牙裔（1.2%）和亚裔（0.6%）。帕金森病患者（131，215）通过门诊和携带者索赔确定。考克斯比例风险模型用于估计与人口统计学和临床变量相关的死亡风险，并在调整种族/民族、性别、年龄和改良Charlson共病评分后，比较帕金森病患者和其他与髋/骨盆骨折后高死亡率相关的医疗条件患者的髋/骨盆骨折后死亡率。在帕金森病患者中，调整协变量后，女性髋部/骨盆骨折后的死亡率低于男性（调整后的风险比[HR] = 0.63，95%置信区间[CI]= 0.62至0.64）。在调整协变量后，与白人相比，黑人的死亡率较高（HR = 1.12，95% CI = 1.09 - 1.16），西班牙裔的死亡率较低（HR = 0.87，95% CI = 0.81 - 0.95）。总的来说，帕金森病患者髋部/骨盆骨折后的校正死亡率（HR = 2.41，95%CI = 2.37至2.46）与未患病者相比显著升高，这一发现与痴呆诊断相关的死亡率增加相似（HR = 2.73，95% CI = 2.68 - 2.79），肾脏疾病（HR = 2.66，95% CI = 2.60 - 2.72）和慢性阻塞性肺疾病（HR = 2.48，95%CI = 2.43 ~ 2.53）。结论：帕金森病患者髋部/骨盆骨折后的死亡率因人口统计学因素而异。在帕金森病患者中，髋部/骨盆骨折后的死亡率显著增加。
BACKGROUND: Parkinson disease is a neurodegenerative disease that affects gait and postural stability, resulting in an increased risk of falling. The purpose of this study was to estimate mortality associated with demographic factors after hip or pelvic (hip/pelvic) fracture in people with Parkinson disease. A secondary goal was to compare the mortality associated with Parkinson disease to that associated with other common medical conditions in patients with hip/pelvic fracture.METHODS: This was a retrospective observational cohort study of 1,980,401 elderly Medicare beneficiaries diagnosed with hip/pelvic fracture from 2000 to 2005 who were identified with use of the Beneficiary Annual Summary File. The race/ethnicity distribution of the sample was white (93.2%), black (3.8%), Hispanic (1.2%), and Asian (0.6%). Individuals with Parkinson disease (131,215) were identified with use of outpatient and carrier claims. Cox proportional hazards models were used to estimate the risk of death associated with demographic and clinical variables and to compare mortality after hip/pelvic fracture between patients with Parkinson disease and those with other medical conditions associated with high mortality after hip/pelvic fracture, after adjustment for race/ethnicity, sex, age, and modified Charlson comorbidity score.RESULTS: Among those with Parkinson disease, women had lower mortality after hip/pelvic fracture than men (adjusted hazard ratio [HR] = 0.63, 95% confidence interval [CI]) = 0.62 to 0.64), after adjustment for covariates. Compared with whites, blacks had a higher (HR = 1.12, 95% CI = 1.09 to 1.16) and Hispanics had a lower (HR = 0.87, 95% CI = 0.81 to 0.95) mortality, after adjustment for covariates. Overall, the adjusted mortality rate after hip/pelvic fracture in individuals with Parkinson disease (HR = 2.41, 95% CI = 2.37 to 2.46) was substantially elevated compared with those without the disease, a finding similar to the increased mortality associated with a diagnosis of dementia (HR = 2.73, 95% CI = 2.68 to 2.79), kidney disease (HR = 2.66, 95% CI = 2.60 to 2.72), and chronic obstructive pulmonary disease (HR = 2.48, 95% CI = 2.43 to 2.53).CONCLUSIONS: Mortality after hip/pelvic fracture in Parkinson disease varies according to demographic factors. Mortality after hip/pelvic fracture is substantially increased among those with Parkinson disease.