Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project

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Abstract

Hip fractures are associated with diminished quality of life and survival especially amongst the elderly.

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Most cited references 26

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Mortality after all major types of osteoporotic fracture in men and women: an observational study.

J R Center, T V Nguyen, D Schneider … (1999)

Mortality increases after hip fractures in women and more so in men. Little is known, however, about mortality after other fractures. We investigated the mortality associated with all fracture types in elderly women and men. We did a 5-year prospective cohort study in the semi-urban city of Dubbo, Australia, of all residents aged 60 years and older (2413 women and 1898 men). Low-trauma osteoporotic fractures that occurred between 1989 and 1994, confirmed by radiography and personal interview, were classified as proximal femur, vertebral, and groupings of other major and minor fractures. We calculated standardised mortality rates from death certificates for people with fractures compared with the Dubbo population. 356 women and 137 men had low-trauma fractures. In women and men, mortality was increased in the first year after all major fractures. In women, age-standardised mortality ratios were 2.18 (95% CI 2.03-2.32) for proximal femur, 1.66 (1.51-1.80) for vertebral, 1.92 (1.70-2.14) for other major, and 0.75 (0.66-0.84) for minor fractures. In men, these ratios were 3.17 (2.90-3.44) for proximal femur, 2.38 (2.17-2.59) for vertebral, 2.22 (1.91-2.52) for other major, and 1.45 (1.25-1.65) for minor fractures. There were excess deaths (excluding minor fractures in women) in all age-groups. All major fractures were associated with increased mortality, especially in men. The loss of potential years of life in the younger age-group shows that preventative strategies for fracture should not focus on older patients at the expense of younger women and of men.

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Test for additive interaction in proportional hazards models.

Rongling Li, Lloyd Ellwood Chambless (2007)

We describe a method for testing and estimating a two-way additive interaction between two categorical variables, each of which has greater than or equal to two levels. We test additive and multiplicative interactions in the same proportional hazards model and measure additivity by relative excess risk due to interaction (RERI), proportion of disease attributable to interaction (AP), and synergy index (S). A simulation study was used to compare the performance of these measures of additivity. Data from the Atherosclerosis Risk in Communities cohort study with a total of 15,792 subjects were used to exemplify the methods. The test and measures of departure from additivity depend neither on follow-up time nor on the covariates. The simulation study indicates that RERI is the best choice of measures of additivity using a proportional hazards model. The examples indicated that an interaction between two variables can be statistically significant on additive measure (RERI=1.14, p=0.04) but not on multiplicative measure (beta3=0.59, p=0.12) and that additive and multiplicative interactions can be in opposite directions (RERI=0.08, beta3=-0.08). The method has broader application for any regression models with a rate as the dependent variable. In the case that both additive and multiplicative interactions are statistically significant and in the opposite direction, the interpretation needs caution.

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The components of excess mortality after hip fracture.

J A Kanis, A Oden, O Johnell … (2003)

A high excess mortality is well described after hip fracture. Deaths are in part related to comorbidity and in part due directly or indirectly to the hip fracture event itself (causally related deaths). The aim of this study was to examine the quantum and pattern of mortality following hip fracture. We studied 160,000 hip fractures in men and women aged 50 years or more, in 28.8 million person-years from the patient register of Sweden, using Poisson models applied to hip fracture patients and the general population. At all ages the risk of death was markedly increased compared with population values immediately after the event. Mortality subsequently decreased over a period of 6 months, but thereafter remained higher than that of the general population. The latter function was assumed to account for deaths related to comorbidity and the residuum assumed to be due to the hip fracture. Causally related deaths comprised 17-32% of all deaths associated with hip fracture (depending on age) and accounted for more than 1.5% of all deaths in the population aged 50 years or more. Hip fracture was a more common cause for mortality than pancreatic or stomach cancer. Thus, interventions that decreased hip fracture rate by, say, 50% would avoid 0.75% or more of all deaths.

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Journal

Title: Journal of Internal Medicine

Abbreviated Title: J Intern Med

Publisher: Wiley

ISSN: 09546820

Publication date Created: March 2017

Publication date (Print): March 2017

Publication date (Electronic): January 17 2017

Volume: 281

Issue: 3

Pages: 300-310

Affiliations

[1 ]Hellenic Health Foundation; Athens Greece

[2 ]School of Medicine; Department of Hygiene, Epidemiology and Medical Statistics; National and Kapodistrian University of Athens; Athens Greece

[3 ]Channing Division of Network Medicine; Brigham and Women's Hospital; Boston MA USA

[4 ]Department of Pharmacology and Clinical Neurosciences and Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden

[5 ]Faculty of Medicine; Department of Community Medicine and Rehabilitation, Geriatric Medicine; Umeå University; Umeå Sweden

[6 ]Department of Community Medicine; UIT The Arctic University of Norway; Tromsø Norway

[7 ]Department of Health and Care Sciences; UIT The Arctic University of Norway; Tromsø Norway

[8 ]Institute of Public Health; College of Medicine and Health Sciences; United Arab Emirates University; Al Ain UAE

[9 ]Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany

[10 ]Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden

[11 ]National Institute of Public Health; Prague Czech Republic

[12 ]Department of Epidemiology and Public Health; University College London; London UK

[13 ]Institute for Translational Epidemiology and Tisch Cancer Institute; Icahn School of Medicine at Mount Sinai; New York NY USA

Article

DOI: 10.1111/joim.12586

PubMed ID: 28093824

SO-VID: c30a2fa7-c45e-4021-b40c-1e0ca5552062

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Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project

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Most cited references 26

Mortality after all major types of osteoporotic fracture in men and women: an observational study.

Test for additive interaction in proportional hazards models.

The components of excess mortality after hip fracture.

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