The effect of low-trauma fracture on one-year mortality rate among privately insured adults with and without neurodevelopmental disabilities.
The effect of low-trauma fracture on one-year mortality rate among privately insured adults with and without neurodevelopmental disabilities.
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低创伤性骨折对有或没有神经发育障碍的私人保险成年人一年死亡率的影响。
DOI：
10.1016/j.bone.2019.115060
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发表时间：
2019
期刊：
影响因子：
4.1
通讯作者：
Jepsen,KarlJ
中科院分区：
文献类型：
--
作者：
Whitney,DanielG;Whibley,Daniel;Jepsen,KarlJ
背景神经发育障碍（NDD）个体在整个生命周期中骨骼健康的发育和保持较差，并且特别容易发生低创伤骨折和骨折后健康并发症。然而，没有研究表明，与没有NDD的成年人相比，NDD的成年人是否有更大的骨折后死亡风险。本研究的目的是确定与无NDDs的成年人相比，患有NDDs的成年人在低创伤骨折后12个月的死亡率是否更高。一个全国性的索赔数据库，来自美国的一个私人付款人。在2012年1月1日至2016年12月31日之间持续低创伤骨折的有和无NDD的患者（18岁以上），以及骨折前慢性疾病（即，心血管疾病、脑血管疾病、糖尿病、慢性阻塞性肺病、癌症）。对有无NDD的成人进行死亡率估计，并计算死亡率比（RR）和95%置信区间（CI）。考克斯回归用于估计风险比（HR）和95%CI，在调整年龄、性别、种族、美国地区和骨折前慢性疾病后，有和无NDD的成人之间骨折后1个月、3个月、6个月和12个月的死亡率。对于NDD成人（n = 3749; 45.2%男性）和无NDD成人（n = 585，910; 34.4%男性）为63.9（19.2）。在12个月的随访期间，182名NDD成人（平均年龄[SD] = 69.8 [14.7]; 46.2%男性）和25，456名无NDD成人（平均年龄[SD] = 78.9 [9.8]; 38.3%男性）死亡。在任何时间点，有和没有NDD的成年人之间的粗死亡率都没有差异（例如，12个月：5.40 vs. 4.96/100人年; RR = 1.09; 95% CI = 0.94-1.26）;然而，与无NDD的成人相比，智障成人的死亡率更高（RR = 1.46; 95% CI = 1.23-1.79）。调整后，NDD成人在3个月、6个月和12个月的时间点有更高的骨折后死亡率（例如，12个月：HR = 1.46; 95% CI = 1.27-1.69）。当按NDD类型分层时，智力残疾的成年人和自闭症谱系障碍的成年人，但不是脑瘫的成年人，有更大的骨折后12个月死亡风险。当按骨折部位分层时，下肢与更高的粗死亡率相关（RR = 1.69; 95% CI = 1.22-2.35）和校正的死亡风险（HR = 2.41; 95%CI = 1.73-3.35），而上肢与更大的校正死亡风险相关（HR = 1.76; 95%CI = 1.23-2.50）为成年人与无NDDs.ConclusionsAmong私人投保的成年人NDDs，低创伤骨折与骨折事件1年内的死亡率风险更大，即使调整骨折前慢性疾病。研究结果表明，需要早期骨折预防策略和改善骨折后的医疗管理。
BackgroundIndividuals with neurodevelopmental disabilities (NDDs) have poor development and preservation of skeletal health throughout the lifespan, and are especially vulnerable to low-trauma fracture and post-fracture health complications. However, no studies have examined if adults with NDDs have greater post-fracture mortality risk compared to adults without NDDs. The purpose of this study was to determine whether adults with NDDs have greater 12-month mortality rates following a low-trauma fracture compared to adults without NDDs.MethodsData from 2011 to 2017 was leveraged from Optum Clinformatics® Data Mart; a nationwide claims database from a single private payer in the U.S. Data were extracted from adults (18+ years) with and without NDDs that sustained a low-trauma fracture between 01/01/2012–12/31/2016, as well as pre-fracture chronic diseases (i.e., cardiovascular diseases, cerebrovascular diseases, diabetes, chronic obstructive pulmonary diseases, cancer). Mortality rate was estimated for adults with and without NDDs, and the mortality rate ratio (RR) and 95% confidence interval (CI) was calculated. Cox regression was used to estimate hazard ratio (HR) and 95% CI for 1-, 3-, 6-, and 12-month post-fracture mortality rates between adults with and without NDDs after adjusting for age, sex, race, U.S. region, and pre-fracture chronic diseases.ResultsMean age (SD) at baseline was 56.7 (20.6) for adults with NDDs (n = 3749; 45.2% men) and 63.9 (19.2) for adults without NDDs (n = 585,910; 34.4% men). During the 12-month follow-up period, 182 adults with NDDs (mean age [SD] = 69.8 [14.7]; 46.2% men) and 25,456 adults without NDDs (mean age [SD] = 78.9 [9.8]; 38.3% men) died. Crude mortality rate was not different between adults with and without NDDs for any time points (e.g., 12-months: 5.40 vs. 4.96 per 100 person years; RR = 1.09; 95% CI = 0.94–1.26); however, it was greater for adults with intellectual disabilities compared to adults without NDDs (RR = 1.46; 95% CI = 1.23–1.79). After adjustments, adults with NDDs had greater post-fracture mortality rates for 3-, 6-, and 12-month time points (e.g., 12-months: HR = 1.46; 95% CI = 1.27–1.69). When stratified by the type of NDD, adults with intellectual disabilities and adults with autism spectrum disorders, but not adults with cerebral palsy, had greater 12-month post-fracture mortality risk. When stratified by fracture location, lower extremities were associated with greater crude mortality rate (RR = 1.69; 95% CI = 1.22–2.35) and adjusted mortality risk (HR = 2.41; 95% CI = 1.73–3.35), while upper extremities were associated with greater adjusted mortality risk (HR = 1.76; 95% CI = 1.23–2.50) for adults with vs. without NDDs.ConclusionsAmong privately insured adults with NDDs, low-trauma fracture is associated with greater mortality risk within 1 year of the fracture event, even after adjusting for pre-fracture chronic diseases. Study findings suggest the need for earlier fracture prevention strategies and improved post-fracture healthcare management.
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