Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland
Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland
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DOI：
10.1007/s00198-004-1696-0
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发表时间：
2005-03-01
影响因子：
4
通讯作者：
Greiner, Roger
中科院分区：
文献类型：
--
作者：
Lippuner, Kurt;Golder, Matthias;Greiner, Roger
本研究的目的是估计2000年瑞士所有骨折和退行性骨折的住院发病率和住院总天数，并将其与男性和女性其他常见疾病的数据进行比较。使用了瑞士联邦统计局2000年以来的官方行政和医疗统计数据库。它涵盖了所有登记患者入院的81.2%，被认为是整个人口的代表。我们纳入了与潜在骨质疏松症兼容的84个诊断的ICD-10代码，并将ICD-9诊断代码发布的最佳匹配年龄特异性骨质疏松症归因率应用于单个ICD-10代码。为了保持与1992年以前发表的数据的可比性，我们将与ICD-10骨折编码相关的数据分为7个诊断池（中轴骨骨折，上肢近端骨折，上肢远端骨折，下肢近端骨折，下肢远端骨折，多发性骨折和骨质疏松症），并按年龄组分别对女性和男性进行分析。计算骨折住院发生率，并估算与骨折住院相关的直接医疗费用。此外，我们将结果与来自同一数据库的慢性阻塞性肺疾病（COPD）、中风、急性心肌梗死、心力衰竭、糖尿病和乳腺癌的结果进行了比较。在瑞士，2000年登记的因骨折住院人数为62 535人（35 586名妇女和26 949名男子）。51%的女性骨折和24%的男性骨折被认为是骨质疏松性骨折。女性和男性因骨折住院的总发生率分别为每100 000人中有969人和768人。65岁以后，下肢近端骨折和中轴骨骨折的住院率呈指数增长。骨质疏松症和/或相关骨折患者住院的直接医疗费用为3.57亿瑞士法郎。髋部骨折约占妇女和男子这些费用的一半。在妇女和男子的其他常见疾病中，骨质疏松症在妇女中排名第一，在男子中排名第二（仅次于慢性阻塞性肺病）。与1992年的数据相比，妇女的平均住院时间缩短了8.4天，男子缩短了4.7天，导致与急性住院有关的直接医疗费用减少了近40%。费用的明显减少可能是由于转向流动费用部分，需要为此开发评估和管理工具。我们的结论是，在2000年，骨质疏松症仍然是瑞士医疗保健系统的沉重负担。缺乏对这种疾病及其后果的认识，阻碍了抗骨折药物的广泛使用。这限制了他们降低成本的潜力。
The aim of this study was to estimate the hospitalization incidence and the total number of hospital days related to all fractures and osteoporotic fractures in the year 2000 in Switzerland and to compare these with data from other frequent disorders in men and women. The official administrative and medical statistics database of the Swiss Federal Office of Statistics (SFOS) from the year 2000 was used. It covered 81.2% of all registered patient admissions and was considered to be representative of the entire population. We included the ICD-10 codes of 84 diagnoses that were compatible with an underlying osteoporosis and applied the best matching age-specific osteoporosis attribution rates published for the ICD-9 diagnosis codes to the individual ICD-10 codes. To preserve comparability with previously published data from 1992, we grouped the data related to the ICD-10 fracture codes into seven diagnosis pools (fractures of the axial skeleton, fractures of the proximal upper limbs, fractures of the distal upper limbs, fractures of the proximal lower limbs, fractures of the distal lower limbs, multiple fractures, and osteoporosis) and analyzed them separately for women and men by age group. Incidences of hospitalization due to fractures were calculated, and the direct medical costs related to hospitalization were estimated. In addition, we compared the results with those from chronic pulmonary obstructive disease (COPD), stroke, acute myocardial infarction, heart failure, diabetes and breast carcinoma from the same database. In Switzerland during 2000, 62,535 hospitalizations for fractures (35,586 women and 26,949 men) were registered. Fifty-one percent of all fractures in women and 24% in men were considered as osteoporotic. The overall incidences of hospitalization due to fractures were 969 and 768 per 100,000 in women and men, respectively. The hospitalization incidences for fractures of the proximal lower limbs and the axial skeleton increased exponentially after the age of 65 years. The direct medical cost of hospitalization of patients with osteoporosis and/or related fractures was 357 million CHF. Hip fractures accounted for approximately half of these costs in women and men. Among other common diseases in women and men, osteoporosis ranked number 1 in women and number 2 ( behind COPD) in men. When compared with data from 1992, the average length of stay had shortened by 8.4 days for women and 4.7 days for men, leading to a decrease of almost 40% in direct medical costs related to acute hospitalizations. This apparent decrease in cost might result from a shift into the ambulatory cost segment, for which the assessment and management tools need to be developed. We conclude that, in 2000, osteoporosis continued to be a heavy burden on the Swiss healthcare system. Lack of awareness of the disease and its consequences prevents widespread use of drugs with anti-fracture efficacy. This limits their potential to reduce costs.