Adjusted mortality after hip fracture: From the cardiovascular health study.
OBJECTIVE
To estimate the risk of death associated with hip fracture (HFx), stratifying by sex and time since fracture.


METHODS
Prospective cohort study compared participants with and without hip fracture, matched on sex, age, race, recruitment period, and time since enrollment.


METHODS
The Cardiovascular Health Study, a more-than-15-year longitudinal study of 5,888 older individuals from four U.S. sites.


METHODS
Three hundred seventy-nine individuals with HFx were compared with 1,134 without HFx.


METHODS
Extended Cox models were used to estimate mortality hazard ratios (HRs) for different periods after fracture, adjusting for prefracture health.


RESULTS
Age- and race-adjusted excess mortality was 9% in women and 24% in men 1 year after fracture, and 24% in women and 26% men 5 years postfracture. Multivariable-adjusted HRs of mortality associated with HFx in women were 7.1 (95% confidence interval (CI) = 2.3-21.5), 2.1 (95% CI = 1.0-4.1), 1.4 (95% CI = 1.1-2.0), and 1.0 (95% CI = 0.6-1.5) for 0 to 1 months, 2 to 6 months, 7 months to 4 years, and 5 to 8 years, respectively, after index date. In men, respective HRs for the same time periods were 39.9 (95% CI = 5.2-308.7), 3.8 (95% CI = 1.4-10.3), 1.1 (95% CI = 0.7-1.8), and 1.0 (95% CI = 0.3-2.7). HRs adjusted for age and race were 20% to 40% higher.


CONCLUSIONS
The risk of mortality was highest in the first 6 months after HFx. In men, the risk of death approximated that of men without HFx after 6 months; in women, a moderately greater risk persisted through the fourth year. Although the mortality pattern was different in women and men, excess mortality 5 years postfracture was similar for both sexes.
Robbins
John A
JA
Department of Medicine, University of California at Davis, Davis, California, USA. jarobbins@ucdavis.edu
Biggs
Mary L
ML
Cauley
Jane
J
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009026:Mortality; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D017678:Sex Distribution; D013997:Time Factors; D014481:United States / Q000453:epidemiology