Excess mortality following hip fracture: The role of underlying health status

A. N A Tosteson, D. J. Gottlieb, D. C. Radley, E. S. Fisher, L. J. Melton

Research output: Contribution to journalArticle

153 Citations (Scopus)

Abstract

Summary: We evaluated the long-term excess mortality associated with hip fracture, using prospectively collected data on pre-fracture health and function from a nationally representative sample of U.S. elders. Although mortality was elevated for the first six months following hip fracture, we found no evidence of long-term excess mortality. Introduction: The long-term excess mortality associated with hip fracture remains controversial. Methods: To assess the association between hip fracture and mortality, we used prospectively collected data on pre-fracture health and function from a representative sample of U.S. elders in the Medicare Current Beneficiary Survey (MCBS) to perform survival analyses with time-varying covariates. Results: Among 25,178 MCBS participants followed for a median duration of 3.8 years, 730 sustained a hip fracture during follow-up. Both early (within 6 months) and subsequent mortality showed significant elevations in models adjusted only for age, sex and race. With additional adjustment for pre-fracture health status, functional impairments, comorbid conditions and socioeconomic status, however, increased mortality was limited to the first six months after fracture (hazard ratio [HR]: 6.28, 95% CI: 4.82, 8.19). No increased mortality was evident during subsequent follow-up (HR: 1.04, 95% CI: 0.88, 1.23). Hip-fracture-attributable population mortality ranged from 0.5% at age 65 among men to 6% at age 85 among women. Conclusions: Hip fracture was associated with substantially increased mortality, but much of the short-term risk and all of the long-term risk was explained by the greater frailty of those experiencing hip fracture.

Original languageEnglish (US)
Pages (from-to)1463-1472
Number of pages10
JournalOsteoporosis International
Volume18
Issue number11
DOIs
StatePublished - Nov 2007

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Hip Fractures
Health Status
Mortality
Medicare
Health
Survival Analysis
Social Class

Keywords

  • Attributable risk
  • Hip fracture
  • Mortality
  • Osteoporosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tosteson, A. N. A., Gottlieb, D. J., Radley, D. C., Fisher, E. S., & Melton, L. J. (2007). Excess mortality following hip fracture: The role of underlying health status. Osteoporosis International, 18(11), 1463-1472. https://doi.org/10.1007/s00198-007-0429-6

Excess mortality following hip fracture : The role of underlying health status. / Tosteson, A. N A; Gottlieb, D. J.; Radley, D. C.; Fisher, E. S.; Melton, L. J.

In: Osteoporosis International, Vol. 18, No. 11, 11.2007, p. 1463-1472.

Research output: Contribution to journalArticle

Tosteson, ANA, Gottlieb, DJ, Radley, DC, Fisher, ES & Melton, LJ 2007, 'Excess mortality following hip fracture: The role of underlying health status', Osteoporosis International, vol. 18, no. 11, pp. 1463-1472. https://doi.org/10.1007/s00198-007-0429-6
Tosteson, A. N A ; Gottlieb, D. J. ; Radley, D. C. ; Fisher, E. S. ; Melton, L. J. / Excess mortality following hip fracture : The role of underlying health status. In: Osteoporosis International. 2007 ; Vol. 18, No. 11. pp. 1463-1472.
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