TREATMENT AND SURVIVAL AMONG ELDERLY AMERICANS WITH HIP-FRACTURES - A POPULATION-BASED STUDY
TREATMENT AND SURVIVAL AMONG ELDERLY AMERICANS WITH HIP-FRACTURES - A POPULATION-BASED STUDY
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DOI：
10.2105/ajph.84.8.1287
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发表时间：
1994-08-01
影响因子：
12.7
通讯作者：
FISHER, ES
中科院分区：
文献类型：
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作者：
LUYAO, GL;BARON, JA;FISHER, ES
目标。本研究旨在研究美国老年髋部骨折患者的治疗模式和生存率。在1986年至1989年期间，有5%的国家医疗保险索赔样本被用来确定髋部骨折的患者。在比较不同地区的治疗模式时，使用直接标准化来得出年龄和种族调整后的百分比。采用Logistic回归和Cox回归对短期和长期生存率进行检验。在美国，64%的股骨颈骨折采用关节置换术治疗；90%的股骨粗隆骨折采用内固定治疗。较高的短期和长期死亡率与男性、年龄较大、骨折前住在养老院、合并症评分较高以及股骨粗隆骨折有关。黑人和白人骨折后90天的死亡率相似，但黑人随后的死亡率更高。对于股骨颈骨折，与关节置换术相比，内固定术的短期死亡率略低。髋部骨折的治疗方法变化不大。黑人髋部骨折后延迟死亡率的增加需要进一步研究。
Objectives. This study was undertaken to examine the patterns of treatment and survival among elderly Americans with hip fracture.Methods. A 5% national sample of Medicare claims was used to identify patients who sustained hip fractures between 1986 and 1989. In comparing treatment patterns across regions, direct standardization was used to derive age- and race-adjusted percentages. Logistic regression and Cox regression were used to examine short- and long-term survival.Results. In the United States, 64% of femoral neck fractures were treated with arthroplasty; 90% of pertrochanteric fractures were treated with internal fixation. Higher short- and long-term mortality was associated with being male, being older, residing in a nursing home prior to fracture, having a higher comorbidity score, and having a pertrochanteric fracture. Blocks and Whites had similar 90-day postfracture mortality, but Blacks had a higher mortality later on. For femoral neck fracture, internal fixation has a modestly lower short-term mortality associated with it than arthroplasty has.Conclusion. Variation in the treatment of hip fracture was modest. The increased delayed mortality after hip fracture among Blacks requires further study.