Thirty-five–year Trends in First-time Hospitalization for Hip Fracture, 1-year Mortality, and the Prognostic Impact of Comorbidity: A Danish Nationwide Cohort Study, 1980–2014

We examined trends in hip fracture incidence in Denmark from 1980 to 2014, trends in subsequent 1-year mortality, and the prognostic impact of sex, age, and comorbidity. This nationwide cohort study prospectively collected data from population-based Danish registries. We included 262,437 patients wi...

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Veröffentlicht in:Epidemiology (Cambridge, Mass.) Mass.), 2017-11, Vol.28 (6), p.898-905
Hauptverfasser: Pedersen, Alma B., Ehrenstein, Vera, Szépligeti, Szimonetta K., Lunde, Astrid, Lagerros, Ylva Trolle, Westerlund, Anna, Tell, Grethe S., Sørensen, Henrik T.
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container_end_page 905
container_issue 6
container_start_page 898
container_title Epidemiology (Cambridge, Mass.)
container_volume 28
creator Pedersen, Alma B.
Ehrenstein, Vera
Szépligeti, Szimonetta K.
Lunde, Astrid
Lagerros, Ylva Trolle
Westerlund, Anna
Tell, Grethe S.
Sørensen, Henrik T.
description We examined trends in hip fracture incidence in Denmark from 1980 to 2014, trends in subsequent 1-year mortality, and the prognostic impact of sex, age, and comorbidity. This nationwide cohort study prospectively collected data from population-based Danish registries. We included 262,437 patients with incident hip fracture and assessed comorbidity using the Charlson Comorbidity Index (CCI). Despite slight increases in incidence rates (IRs) of hip fracture up to the mid-1990s, the annual IR decreased by 29% from 1980 to 2014 in women but remained stable in men. Decrease affected all age groups. IR decreased in patients without comorbidity but increased with increasing comorbidity (13% in patients with moderate and 510% in patients with very severe comorbidity). Adjusted mortality rate ratios (MRRs) following hip fracture in 2010-2014 compared with 1980-1984 were 0.68 (95% confidence interval [CI] = 0.65, 0.71) within 30 days and 0.63 (95% CI = 0.61, 0.66) within 31-365 days. The mortality decreased up to 40% irrespective of comorbidity. Compared with patients with no comorbidity, those with very severe comorbidity had adjusted MRRs of 2.48 (95% CI = 2.39, 2.56) and 2.81 (95% CI = 2.74, 2.88) within 30 days and 31-365 days post-hip fracture, respectively. Although the incidence rate of hip fracture increased substantially with increasing comorbidity, the following 1-year mortality decreased by 40% from 1980 through 2014 irrespective of sex, age, and comorbidity level, suggesting improvement in both treatment and rehabilitation of patients with hip fracture. Comorbidity burden was, however, a strong prognostic factor for 1-year mortality after hip fracture.
doi_str_mv 10.1097/EDE.0000000000000729
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Compared with patients with no comorbidity, those with very severe comorbidity had adjusted MRRs of 2.48 (95% CI = 2.39, 2.56) and 2.81 (95% CI = 2.74, 2.88) within 30 days and 31-365 days post-hip fracture, respectively. Although the incidence rate of hip fracture increased substantially with increasing comorbidity, the following 1-year mortality decreased by 40% from 1980 through 2014 irrespective of sex, age, and comorbidity level, suggesting improvement in both treatment and rehabilitation of patients with hip fracture. 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Compared with patients with no comorbidity, those with very severe comorbidity had adjusted MRRs of 2.48 (95% CI = 2.39, 2.56) and 2.81 (95% CI = 2.74, 2.88) within 30 days and 31-365 days post-hip fracture, respectively. Although the incidence rate of hip fracture increased substantially with increasing comorbidity, the following 1-year mortality decreased by 40% from 1980 through 2014 irrespective of sex, age, and comorbidity level, suggesting improvement in both treatment and rehabilitation of patients with hip fracture. 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Ehrenstein, Vera ; Szépligeti, Szimonetta K. ; Lunde, Astrid ; Lagerros, Ylva Trolle ; Westerlund, Anna ; Tell, Grethe S. ; Sørensen, Henrik T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c316t-17c13cf478f1b3613a9302742bba34d5b1d29135fb3914292d9f5a42dbb065603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Denmark - epidemiology</topic><topic>Descriptive Epidemiology</topic><topic>Female</topic><topic>Hip Fractures - epidemiology</topic><topic>Hospitalization - trends</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pedersen, Alma B.</creatorcontrib><creatorcontrib>Ehrenstein, Vera</creatorcontrib><creatorcontrib>Szépligeti, Szimonetta K.</creatorcontrib><creatorcontrib>Lunde, Astrid</creatorcontrib><creatorcontrib>Lagerros, Ylva Trolle</creatorcontrib><creatorcontrib>Westerlund, Anna</creatorcontrib><creatorcontrib>Tell, Grethe S.</creatorcontrib><creatorcontrib>Sørensen, Henrik T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>Epidemiology (Cambridge, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pedersen, Alma B.</au><au>Ehrenstein, Vera</au><au>Szépligeti, Szimonetta K.</au><au>Lunde, Astrid</au><au>Lagerros, Ylva Trolle</au><au>Westerlund, Anna</au><au>Tell, Grethe S.</au><au>Sørensen, Henrik T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thirty-five–year Trends in First-time Hospitalization for Hip Fracture, 1-year Mortality, and the Prognostic Impact of Comorbidity: A Danish Nationwide Cohort Study, 1980–2014</atitle><jtitle>Epidemiology (Cambridge, Mass.)</jtitle><addtitle>Epidemiology</addtitle><date>2017-11-01</date><risdate>2017</risdate><volume>28</volume><issue>6</issue><spage>898</spage><epage>905</epage><pages>898-905</pages><issn>1044-3983</issn><eissn>1531-5487</eissn><abstract>We examined trends in hip fracture incidence in Denmark from 1980 to 2014, trends in subsequent 1-year mortality, and the prognostic impact of sex, age, and comorbidity. This nationwide cohort study prospectively collected data from population-based Danish registries. We included 262,437 patients with incident hip fracture and assessed comorbidity using the Charlson Comorbidity Index (CCI). Despite slight increases in incidence rates (IRs) of hip fracture up to the mid-1990s, the annual IR decreased by 29% from 1980 to 2014 in women but remained stable in men. Decrease affected all age groups. IR decreased in patients without comorbidity but increased with increasing comorbidity (13% in patients with moderate and 510% in patients with very severe comorbidity). Adjusted mortality rate ratios (MRRs) following hip fracture in 2010-2014 compared with 1980-1984 were 0.68 (95% confidence interval [CI] = 0.65, 0.71) within 30 days and 0.63 (95% CI = 0.61, 0.66) within 31-365 days. The mortality decreased up to 40% irrespective of comorbidity. Compared with patients with no comorbidity, those with very severe comorbidity had adjusted MRRs of 2.48 (95% CI = 2.39, 2.56) and 2.81 (95% CI = 2.74, 2.88) within 30 days and 31-365 days post-hip fracture, respectively. Although the incidence rate of hip fracture increased substantially with increasing comorbidity, the following 1-year mortality decreased by 40% from 1980 through 2014 irrespective of sex, age, and comorbidity level, suggesting improvement in both treatment and rehabilitation of patients with hip fracture. Comorbidity burden was, however, a strong prognostic factor for 1-year mortality after hip fracture.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc</pub><pmid>28767515</pmid><doi>10.1097/EDE.0000000000000729</doi><tpages>8</tpages></addata></record>
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subjects Aged
Aged, 80 and over
Cause of Death
Cohort Studies
Comorbidity
Denmark - epidemiology
Descriptive Epidemiology
Female
Hip Fractures - epidemiology
Hospitalization - trends
Humans
Incidence
Male
Middle Aged
Mortality
Prognosis
Prospective Studies
Registries
title Thirty-five–year Trends in First-time Hospitalization for Hip Fracture, 1-year Mortality, and the Prognostic Impact of Comorbidity: A Danish Nationwide Cohort Study, 1980–2014
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