Excess mortality following hip fracture: the role of underlying health status.
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.


BACKGROUND
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.
Tosteson
A N A
AN
Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Lebanon, NH 03756, USA. anna.tosteson@dartmouth.edu
Gottlieb
D J
DJ
Radley
D C
DC
Fisher
E S
ES
Melton
L J
LJ
D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006620:Hip Fractures / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D008297:Male; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology