Incidence and mortality of hip fractures in the United States.
Incidence and mortality of hip fractures in the United States.
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DOI：
10.1001/jama.2009.1462
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发表时间：
2009-10-14
影响因子：
120.7
通讯作者：
Rosen, Allison B
中科院分区：
文献类型：
--
作者：
Brauer, Carmen A;Coca-Perraillon, Marcelo;Cutler, David M;Rosen, Allison B
了解髋部骨折的发病率和随后的死亡率对于衡量人口健康和改善医疗保健的价值至关重要。研究 20 年来美国医疗保险人群髋部骨折发生率及其死亡率的趋势。使用 1985 年至 2005 年 20% 医疗保险索赔样本数据进行的观察性研究。在 65 岁或以上的患者中，我们确定了 786 717 例髋部骨折进行分析。用药数据来自 1992 年至 2005 年间 Medicare 当前受益人调查的 109 805 名受访者。年龄和性别特定的髋部骨折发生率以及年龄和风险调整死亡率。 1986 年至 2005 年间，女性髋部骨折的年平均人数为每 10 万人中 957.3 人（95% 置信区间 [CI]，921.7-992.9），男性为每 10 万人中 414.4 人（95% CI，401.6-427.3）。年龄调整后的髋部骨折发病率从 1986 年至 1995 年有所增加，然后从 1995 年至 2005 年稳步下降。在女性中，发病率增加了 9.0%，从 1986 年的每 10 万人中 964.2 例（95% CI，958.3-970.1）增加到 1050.9（95% CI， 1995 年，发病率从 1045.2-1056.7）下降到 2005 年的 793.5（95% CI，788.7-798.3）。在男性中，从 1986 年到 1995 年，发病率从 392.4（95% CI，788.7-798.3）增加了 16.4%。 387.8–397.0）至 456.6（95% CI，452.0–461.3），随后到 2005 年下降 19.2%，至 369.0（95% CI，365.1–372.8）。女性 30 天、180 天和 360 天死亡率的年龄和风险调整死亡率分别下降了 11.9%、14.9% 和 8.8%。对于男性来说，30 天、180 天和 360 天死亡率的年龄和风险调整死亡率分别下降了 21.8%、25.4% 和 20.0%。随着时间的推移，髋部骨折患者除瘫痪外的所有合并症均有所增加。发病率的下降与双膦酸盐使用的增加同时发生。在美国，65 岁及以上人群的髋部骨折率和随后的死亡率正在下降，而髋部骨折患者的合并症却有所增加。
Understanding the incidence and subsequent mortality following hip fracture is essential to measuring population health and the value of improvements in health care. To examine trends in hip fracture incidence and resulting mortality over 20 years in the US Medicare population. Observational study using data from a 20% sample of Medicare claims from 1985–2005. In patients 65 years or older, we identified 786 717 hip fractures for analysis. Medication data were obtained from 109 805 respondents to the Medicare Current Beneficiary Survey between 1992 and 2005. Age- and sex-specific incidence of hip fracture and age-and risk-adjusted mortality rates. Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100 000 (95% confidence interval [CI], 921.7–992.9) for women and 414.4 per 100 000 (95% CI, 401.6–427.3) for men. The age-adjusted incidence of hip fracture increased from 1986 to 1995 and then steadily declined from 1995 to 2005. In women, incidence increased 9.0%, from 964.2 per 100 000 (95% CI, 958.3–970.1) in 1986 to 1050.9 (95% CI, 1045.2–1056.7) in 1995, with a subsequent decline of 24.5% to 793.5 (95% CI, 788.7–798.3) in 2005. In men, the increase in incidence from 1986 to 1995 was 16.4%, from 392.4 (95% CI, 387.8–397.0) to 456.6 (95% CI, 452.0–461.3), and the subsequent decrease to 2005 was 19.2%, to 369.0 (95% CI, 365.1–372.8). Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-, 180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively. Over time, patients with hip fracture have had an increase in all comorbidities recorded except paralysis. The incidence decrease is coincident with increased use of bisphosphonates. In the United States, hip fracture rates and subsequent mortality among persons 65 years and older are declining, and comorbidities among patients with hip fractures have increased.