Mortality following the diagnosis of a vertebral compression fracture in the Medicare population
Mortality following the diagnosis of a vertebral compression fracture in the Medicare population
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DOI：
10.2106/jbjs.g.00675
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发表时间：
2008-07-01
影响因子：
5.3
通讯作者：
Edidin, Av
中科院分区：
文献类型：
--
作者：
Lau, Edmund;Ong, Kevin;Edidin, Av
背景资料：女性椎体压缩性骨折与死亡率增加相关，但这一发现的普遍性，作为年龄，性别，种族和地区的函数，在美国整个老年人群中仍不清楚。本研究的目的是评估生存的医疗保险人口与椎骨压缩fractions.Methods：我们进行了一项回顾性的数据分析，医疗保险索赔产生的5%的样本，所有医疗保险登记从1997年到2004年。患者样本包括1997年至2004年新诊断为椎体压缩性骨折的所有97，142例患者。对照组的年龄、性别、种族和医疗保险购买状态相匹配，对照组与病例的比例为五比一。从新发骨折的最早日期至死亡或至研究结束，测量患者的生存期。采用Kaplan-Meier分析和考克斯回归方法计算骨折患者与对照组的死亡率。人口统计学亚群分析和分析的合并症的水平进行，以及。结果：医疗保险患者椎体骨折的总体死亡率是大约两倍的匹配对照。根据Kaplan-Meier方法估计，骨折诊断后3年、5年和7年的生存率分别为53.9%、30.9%和10.5%，均显著低于对照组。男性骨折后的死亡风险高于女性。椎体压缩性骨折的患者和对照组之间的死亡率差异是最大的，当患者在骨折的时间是年轻的，这种差异下降的年龄在fractional.Conclusions：这项研究建立了与椎体骨折的老年患者的死亡风险的所有年龄和种族和性别的医疗保险人口;然而，这并不意味着因果关系。骨折患者和对照组之间的死亡率差异高于以前的报道，即使在控制了合并症之后。证据等级：预后III级。证据等级的完整描述见作者说明。
Background: Vertebral compression fractures in women are associated with increased mortality, but the generality of this finding, as a function of age, sex, ethnicity, and region, among the entire elderly population in the United States remains unclear. The objective of this study was to assess the survival of the Medicare population with vertebral compression fractures.Methods: We conducted a retrospective data analysis of Medicare claims generated by a 5% sample of all Medicare enrollees from 1997 through 2004. The patient sample consisted of all 97,142 individuals with a new diagnosis of vertebral compression fracture from 1997 through 2004. Controls were matched for age, sex, race, and Medicare buy-in status, with a five-to-one control-case ratio. The survival of a patient was measured from the earliest date of a new fracture until death or until the end of the study. The patients with a fracture were compared with the controls by calculation of the mortality rates, with use of Kaplan-Meier analysis and the Cox regression method. Demographic subpopulation analysis and analysis by comorbidity levels were performed as well.Results: Medicare patients with a vertebral fracture had an overall mortality rate that was approximately twice that of the matched controls. The survival rates following a fracture diagnosis, as estimated with the Kaplan-Meier method, were 53.9%, 30.9%, and 10.5% at three, five, and seven years, respectively, which were consistently and significantly lower than the rates for the controls. The mortality risk following a fracture was greater for men than for women. The difference in mortality between the patients with a vertebral compression fracture and the controls was greatest when the patients were younger at the time of the fracture; this difference declined as the age at the time of the fracture increased.Conclusions: This study establishes the mortality risk associated with vertebral fractures for elderly patients of all ages and ethnicities and both sexes in the Medicare population; however, it does not imply a causal relationship. The difference in mortality between patients with a fracture and controls is higher than previously reported, even after controlling for comorbidities.Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.