title: Treatment and survival among elderly Americans with hip fractures: a population-based study.
abstract: OBJECTIVE
  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. Blacks 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.
  
  
  CONCLUSIONS
  Variation in the treatment of hip fracture was modest, The increased delayed mortality after hip fracture among Blacks requires further study.
authors.affiliation: Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755-3863.
authors.forename: G L
authors.initials: GL
authors.lastname: Lu-Yao
authors.forename: J A
authors.initials: JA
authors.lastname: Baron
authors.forename: J A
authors.initials: JA
authors.lastname: Barrett
authors.forename: E S
authors.initials: ES
authors.lastname: Fisher
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006302:Health Services Research; D006620:Hip Fractures / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*; D006622:Hip Prosthesis / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012494:Sampling Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology