title: Interstate variation in the burden of fragility fractures.
abstract: Demographic differences may produce interstate variation in the burden of osteoporosis. We estimated the burden of fragility fractures by race/ethnicity, age, sex, and service site across five diverse and populous states. State inpatient databases for 2000 were used to describe hospital fracture admissions, and a Markov decision model was used to estimate annual fracture incidence and cost for populations >or=50 yr of age for 2005-2025 in Arizona (AZ), California (CA), Florida (FL), Massachusetts (MA), and New York (NY). In 2000, mean hospital charges for incident fractures varied 1.7-fold across states. For hip fracture, mean charges ranged from $16,700 (MA) to $29,500 (CA), length of stay from 5.3 (AZ) to 8.9 days (NY), and discharge rate to long-term care from 43% (NY) to 71% (CA). In 2005, projected fracture incidence rates ranged from 199 (CA) to 266 (MA) per 10,000. Total cost ranged from $270 million (AZ) to $1,434 million (CA). Men accounted for 26-30% of costs. Across states, hip fractures constituted on average 77% of costs; "other" fractures (e.g., leg, arm), 10%; pelvic, 6%; vertebral, 5%; and wrist, 2%. By 2025, Hispanics are projected to represent 20% of fractures in AZ and CA and Asian/Other populations to represent 27% of fractures in NY. In conclusion, state initiatives to prevent fractures should include nonwhite populations and men, as well as white women, and should address fractures at all skeletal sites. Interstate variation in service utilization merits further evaluation to determine efficient and effective disease management strategies.
authors.affiliation: Public Policy and Government Relations, Procter & Gamble Health Care, Norwich, New York 13815-0191, USA. king.ab@pg.com
authors.forename: Alison B
authors.initials: AB
authors.lastname: King
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Russel T
authors.initials: RT
authors.lastname: Burge
authors.forename: Bess
authors.initials: B
authors.lastname: Dawson-Hughes
mesh_terms: D004469:Economics, Hospital; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000453:epidemiology*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology